Will a long COVID exacerbate existing health and employment disparities?

Early data show that as of August 8, 2022, the rate of self-reported persistent COVID was one-quarter to one-third higher among female, transgender, Hispanic, and non-high school aged adults than among all adults (Figure 1). In this policy watch, we explore how these higher rates of prolonged COVID could exacerbate existing disparities in health and employment using new data on prolonged COVID from the Household Heart Rate Survey as reported by the Centers for Disease Control and Prevention diseases (CDC). The Pulse survey is an experimental study providing information on how the COVID pandemic is affecting households socially and economically. Its main advantage is its 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 the long COVID. Although these early data provide some important insights into the prevalence of long-term COVID, to date the sample includes only about 150,000 respondents, limiting the reliability of the findings and the ability to detect differences between groups. This policy observation focuses on characteristics for which CDC has determined that there are sufficient observations to account for differences between groups.

There is no well-established definition of prolonged COVID, but the Pulse survey asked respondents if they had experienced symptoms of COVID that lasted more than 3 months, including “fatigue or tiredness, difficulty thinking, concentrating, forgetfulness, or memory problems (sometimes referred to as “brain fog’), difficulty breathing or shortness of breath, joint or muscle pain, fast or racing heart (also known as palpitations), chest pain, lightheadedness when standing up, menstrual changes, changes in taste/smell, or inability to exercise. There are few other studies that have assessed the socioeconomic consequences of long COVD, but those that have done so are consistent with our findings from the Pulse study.

Household Pulse data shows that rates of persistent COVID are higher among adults who are female (18%) and transgender (19%) compared to male (11%). The difference in rates between men and women has been documented elsewhere: Another study estimated that the prevalence of long COVID before Omicron was 1.4%-2.2% of adult US women compared to only 0.9%-1.7% from adult men. It is not clear what drives the differences in outcomes between women and men, but the patterns are similar to those in other post-infection syndromes, such as chronic fatigue syndrome. These data may be the first published data showing separate rates of long COVID among people who are transgender, and the large confidence interval around the percentage suggests significant uncertainty in the estimate. However, other research suggests that transgender people have lower incomes and poorer health outcomes, which may contribute to greater vulnerability to COVID.

One in five (20%) Hispanic adults reported having ever had prolonged COVID, compared to less than 15% of white, black, or Asian adults. Data were not reported separately for American Indians and Alaska Natives or Native Hawaiians and other Pacific Islanders. There are no studies evaluating the reasons for the higher long-term rates of COVID among Hispanic adults, but their higher rates of COVID infection undoubtedly contribute to the difference. No differences in rates of COVID debt were observed between black and white adults, although black adults had higher age-adjusted rates of COVID infection and death. More research is needed to better understand the racial and ethnic patterns of long-term rates of COVID and their relationship to COVID cases and deaths.

Of adults with less than a high school diploma, 20% reported having long-lasting COVID, compared to only 12% of adults with a college degree. The Pulse data reported by the CDC does not show the distribution of long-term COVID among people based on income or employment outcomes, but there is a well-established relationship between higher levels of education and lower income and earnings, so it is likely that rates of prolonged COVID are higher among people with lower incomes and incomes. It is not clear to what extent higher rates of long-term COVID cases are a result of reduced access to health care before infection, but a study of long-term rates of COVID in the UK found socioeconomic deprivation to be a risk factor. Analyzes of future Pulse data with larger sample sizes will be helpful in determining whether similar patterns exist in the US

Because prolonged COVID disproportionately affects working-age people, it may worsen employment outcomes in addition to health. Consistent with other studies, the Pulse data show that rates of sustained COVID are highest among adults in their working years. (Probably the very low rates of prolonged COVID among people over age 60 reflect the higher mortality from COVID among this population.) Current research shows that prolonged COVID significantly affects 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 had one-week absences from work related to COVID were significantly less likely to work than similar workers who did not. have missed a week of work for health reasons. And a recent analysis of survey data found that 26% of people with long-term COVID reported that it had affected their employment.

In the future, a prolonged COVID may reinforce existing differences in society. Even before the pandemic, women were more likely to work in low-wage jobs or be paid less for similar levels of work than men, and the pandemic had a particularly damaging impact on women’s employment compared to men’s. Likewise, higher rates of sustained COVID among Hispanic adults may further exacerbate disparities in health, employment, and income among this group, which were already more severely affected by the pandemic. Another study found that Hispanic and black adults had higher levels of workplace exposure, which contributed to higher prevalence of COVID—and ultimately, prolonged COVID. The Pulse data suggest that the effects of prolonged COVID — like the effects of the pandemic more broadly — may fall disproportionately among adults who are already experiencing disparities in health and employment outcomes. The sample size is currently too small to analyze differences between some populations. Future KFF analysis will use additional waves of Pulse survey data to further examine differences between groups that differ by race, ethnicity, income, employment, and other relevant characteristics.

In releasing two new reports related to those with prolonged COVID, HHS Secretary Becerra wrote: “Prolonged COVID can interfere with an individual’s ability to work, attend school, participate in community life, and engage in daily activities. Existing research reinforces the urgent need to understand the effects of prolonged COVID on people: A recent study indicates that 4 million people may be out of work in the US as a result of prolonged COVID. The implications are magnified when one considers that job loss is concentrated among people who already have lower incomes, lower incomes, and additional challenges accessing health care. In addition, patients with long-term COVID struggle to access disability benefits, which could mitigate some of the financial consequences of not being able to work.As new research on long-term COVID emerges, it will be important to improve our understanding of this who is most likely to be affected, what types of treatments hold the most promise, and what social and economic supports can mitigate the long-term effects of long-term COVID on socioeconomic disparities in the US

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