Will Long COVID exacerbate existing health and employment disparities?

Early data shows that as of August 8, 2022, rates of self-reported long COVID among adults who are female, transgender, Hispanic, and without a college degree are one-fourth to one-third higher than all adults (illustration 1). In this Policy Watch, we examine how these higher rates of long-COVID might exacerbate existing health and employment inequalities, using new long-COVID data from the Household Pulse Survey as published by the Centers for Disease Control and Prevention ( CDC) have been reported. The Pulse survey is an experimental survey that provides information on how the COVID pandemic is affecting households from a social and economic perspective. Its main advantage is short turnaround time, but the data may not meet all of the Census Bureau’s quality standards. In June 2022, the survey began asking questions about long COVID. While these early data provide some important insights into the prevalence of long COVID, the sample so far only includes about 150,000 respondents, limiting the reliability of the results and the ability to spot differences between groups. This policy watch focuses on characteristics for which the CDC has determined that there are enough observations to report differences between groups.

There is no established definition of Long-COVID, but the Pulse survey asked respondents if they had COVID symptoms that lasted longer than 3 months, including “tiredness or exhaustion, difficulty thinking, difficulty concentrating, forgetfulness, or memory problems (sometimes referred to as difficulty breathing or shortness of breath, joint or muscle pain, fasting or pounding heart (also known as palpitations), chest pain, dizziness on standing up, menstrual changes, changes in taste/smell, or inability to exercise.” There are few other studies examining the socioeconomic Assess effects of long-term COVD, but those who do agree with our findings from the Pulse survey.

Household Pulse data shows rates of long-term COVID are higher in adult women (18%) and transgender people (19%) compared to men (11%). The difference in rates between males and females has been documented elsewhere: Another study estimated the prevalence of long pre-Omicron COVID at 1.4% to 2.2% of US adult females, compared to just 0.9% up to 1.7% of adult men. It’s unclear what drives the differences in outcomes between women and men, but the patterns are similar to those seen in other post-infection syndromes, such as chronic fatigue syndrome. This data may be the first published data showing separate rates of long COVID in transgender people, and the large confidence interval around the rate indicates significant uncertainty in the estimate. However, other research shows that transgender people have lower incomes and poorer health, which could contribute to greater vulnerability to COVID.

One in five (20%) Hispanic adults reported ever having had a long-term COVID, compared to fewer than 15% of white, black, or Asian adults. Data for Native Americans and Alaskan Natives or for Hawaiian and other Pacific Islander Natives were not reported separately. There are no studies examining the causes of higher long COVID rates in Hispanic adults, but their higher COVID infection rates undoubtedly contribute to the difference. No differences in long COVID rates are observed between black and white adults, although black adults have higher age-adjusted COVID infection and death rates. Further research is needed to better understand the racial and ethnic patterns of long COVID rates and their relationship to COVID cases and deaths.

Of adults with less than a high school diploma, 20% say they have a long-term COVID, compared to just 12% of adults with a college degree. The Pulse data reported by the CDC does not show the distribution of long-COVID among people based on income or employment outcomes, but there is a well-established relationship between higher educational attainment and lower income and earnings, so it is likely that rates of long COVID are higher among people with lower earnings and income. It is unclear to what extent higher rates of long COVID result from reduced access to pre-infection healthcare, but a study of long COVID rates in the UK found that socioeconomic disadvantage was a risk factor. Analysis of future Pulse data with larger sample sizes will be useful to determine whether similar patterns exist in the US

Because COVID has long disproportionately affected working-age people, it can worsen employment outcomes in addition to health. Consistent with other studies, the Pulse data shows that rates of long COVID are highest among adults in their working years. (It is likely that the very low rates of long COVID in people over the age of 60 reflect higher mortality from COVID in this population.) Recent research shows that long COVID significantly impairs people’s ability to work. While it’s too early to know how long-term these effects may be, a recent study found that people who experienced weeks of COVID-related absence from work were significantly less likely to work than similar workers who not a week was absent from being unable to work for health reasons. And a recent analysis of survey data found that 26% of people with long COVID said it had affected their employment.

Looking ahead, long-established COVID could exacerbate inequalities within society. Even before the pandemic, women were more likely to work low-wage jobs or be paid less than men for similar jobs, and the pandemic had a particularly detrimental impact on women’s employment compared to men’s. Similarly, higher rates of long-COVID among Hispanic adults may further exacerbate health, employment, and income disparities in this group, which has already been harder hit by the pandemic. Another study found that Latinos and Black adults had higher workplace exposures, contributing to higher COVID prevalence — and eventually a long COVID. The Pulse data suggests that the impact of a long COVID — like the impact of the broader pandemic — may be disproportionate among adults who already have disparate health and employment outcomes. Currently the sample size is too small to analyze differences between some populations. Future KFF analyzes will leverage additional waves of Pulse survey data to further examine differences between groups that vary by race, ethnicity, income, employment, and other relevant characteristics.

In releasing two new reports relevant to people with long COVID, HHS Secretary Becerra writes, “Long COVID can affect a person’s ability to work, attend school, participate in community life, and engage in everyday activities participate.” Existing research reinforces the urgency of understanding the impact of a long COVID on people: A recent study shows that 4 million people in the US could be unemployed as a result of a long COVID. The implications are amplified when one considers that job losses are concentrated among people who already have lower incomes, lower earnings and additional challenges in accessing health care. Additionally, long-term COVID patients have difficulty accessing disability benefits, which could mitigate some of the financial consequences of being unable to work. As new research on long COVID is released, it will be important to improve our understanding of who is most likely to be affected, what types of treatments hold the most promise, and what social and economic supports the longer-term consequences of a long COVID on socioeconomic disparities can mitigate in the US

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