Black Patients Underdiagnosed With Long COVID In The US Compared With White Patients

Long COVID has debilitating effects but is inconsistently diagnosed because of subjective criteria, limited treatments, and variations in health care access. We analyzed electronic health records from the National Clinical Cohort Collaborative for patients diagnosed with acute COVID-19 in the US between January 2022 and March 2023. Using six race and ethnicity categories, we evaluated 222 symptoms and long COVID diagnoses (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, code U09.9) within twelve months after infection. We assessed the relationship between race and ethnicity and long COVID diagnosis, adjusting for patient covariates and long COVID symptomatology set to the presence of at least one documented long COVID-associated symptom. Among 2.4 million patients, Black patients were less likely to be diagnosed with long COVID than White patients under a scenario in which a symptom was present and health care monitoring was at least bimonthly. For the remaining racial and ethnic groups, we found no statistically significant differences in long COVID diagnoses compared with White patients. Although the magnitude was small, the difference in diagnosis likelihood suggests the presence of potential diagnostic bias.