Demographic Differences in Long COVID Diagnosis Across Levels of Care: Implications for Clinical Practice

Long COVID is a novel condition primarily studied in outpatient settings, failing to capture the full spectrum of affected patients, particularly those from disadvantaged populations. Demographic differences in the medical encounter setting of initial long COVID diagnosis suggest disparities in symptom severity, care access, and utilization.

To identify demographic factors associated with the encounter setting at initial long COVID diagnosis.

Retrospective study utilizing data from the electronic medical record within the largest Midwestern non-profit healthcare system.

In total, 8008 patients aged 18+ with initial long COVID diagnosis (ICD-10 U09.9) between March 1, 2020, and October 31, 2023.

Demographic factors (age, sex, race/ethnicity, insurance, median household income) and encounter setting at first long COVID diagnosis were extracted. We used multinomial logistic regression to estimate adjusted odds of encounter setting at first diagnosis by demographic subgroup.

Patients were most frequently diagnosed with long COVID in an outpatient non-diagnostic encounter (92%), followed by emergency (3%), outpatient diagnostic (e.g., following laboratory or imaging; 3%), and inpatient (2%). After mutually adjusting for all demographic factors, relative to first long COVID diagnosis in the outpatient non-diagnostic setting, older age was associated with higher odds of first diagnosis in outpatient diagnostic and inpatient settings but lower odds in the emergency setting. Greater median household income was associated with higher odds of first diagnosis in the outpatient diagnostic setting but lower odds in the emergency setting. Patients with Medicaid had lower odds of first diagnosis in the outpatient diagnostic setting but 3.0 times higher odds in emergency settings.

Patients with lower socioeconomic status indicators had increased odds of first long COVID diagnosis in higher acuity settings, suggesting potential differences in symptom severity, access, and care-seeking behaviors. Long COVID research and education should target patients and providers in these settings.