Long COVID Disproportionately Reported by Disadvantaged Individuals: A National Survey of U.S. Working-Age Adults

COVID-19 disproportionately affects racial/ethnic minorities and economically disadvantaged persons, which may also apply to sequelae from acute infection. Little is known about those who live with post-acute sequelae of SARS-CoV-2 infection (PASC), including long COVID, especially those without a formal diagnosis.

To examine self-reported long COVID symptoms and its associations with individual and state characteristics from a national survey sample of working-age adults.

Repeated cross-sectional survey analysis.

Eighteen- to 64-year-old adults who reported ever having had COVID-19 (n = 409,087).

We examined long COVID responses from the online Household Pulse Survey (9/22/2022-10/30/2023), administered by the Census Bureau and the National Center for Health Statistics. Long COVID was defined as having "symptoms lasting 3 months or longer that you did not have prior to having coronavirus" (e.g., fatigue, difficulty thinking, shortness of breath) or not. Logistic regression models adjusted for survey week, respondent characteristics (e.g., demographics, acute COVID-19 severity), and state characteristics (e.g., rurality, Health Professional Shortage Areas). We additionally examined concurrent depression and anxiety symptoms.

The HPS response rate was 6.10% during the study timeframe.¹⁴ Among those who ever had COVID-19, 27.5% reported long COVID symptoms. Among those with long COVID symptoms, 22.6% reported having severe activity limitations. In fully adjusted models, long COVID symptoms were most commonly reported by Hispanic respondents (ΔP_H = 2.3, SE = 0.7), among all racial-ethnic groups. Low socioeconomic status was consistently associated with long COVID symptoms: Income (ΔP_{<25k vs >=200k+} = 11.9, SE = 0.9); Medicaid-insurance (ΔP_{Medicaid v Employer-sponsored} = 02.9, SE = 0.5); Uninsurance (ΔP_{Uninsured v Employer-sponsored} = 1.8, SE = 0.4). Long COVID symptoms were associated with living in more rural states (ΔP = 0.08, SE = 0.02). Long COVID symptoms were additionally associated with concurrent anxiety (ΔP_{Anx v Not} = 8.0, SE = 0.4) and depressive symptoms (ΔP_{Dep v Not} = 6.7, SE = 0.6).

Long COVID symptoms and disability were disproportionately reported among survey respondents who were Hispanic and who were economically-disadvantaged. Rural communities were more so impacted.