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Will the long COVID exacerbate existing disparities in health and employment?

Early data shows that as of August 8, 2022, self-reported long COVID rates are one-quarter to one-third higher among female, transgender, Hispanic, and adults without a high school diploma than among all adults (Figure 1). In this policy watch, we explore how these higher rates of long COVID could be exacerbating existing disparities in health and employment using new data on long COVID from the Household Pulse Survey, as reported by the Centers for Disease Control and Prevention (CDC). The Pulse survey is an experimental survey providing information on how the COVID pandemic is affecting households from a social and economic perspective. Its main advantage is the short turnaround time, but the data may not meet all Census Bureau quality standards. In June 2022, the survey began asking about long COVID. While these early data provide important insights into the prevalence of long COVID, to date the sample only includes approximately 150,000 respondents, which limits the reliability of the results and the ability to detect 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 well-established definition of long COVID, but the Pulse survey asked respondents if they had symptoms of COVID that lasted more than 3 months, including “tiredness or tiredness, trouble thinking, concentrating , forgetfulness or memory problems (sometimes referred to as “brain fog”), difficulty breathing or shortness of breath, joint or muscle pain, rapid heartbeat or palpitations (also called heart palpitations), chest pain, dizziness when standing, menstrual changes , changes in taste/smell, or inability to exercise. There are few other studies that assess the socioeconomic implications of long-term COVD, but those that do are consistent with our findings from the Pulse survey.

Data from Household Pulse shows that rates of long COVID are higher among female (18%) and transgender (19%) adults than among men (11%). The difference in rates between men and women has been documented elsewhere: another study estimated the prevalence of long pre-Omicron COVID to be 1.4% to 2.2% of adult women in the United States, compared to only 0.9% to 1.7% of adult men. It is unclear what drives the differences in outcomes between women and men, but the patterns are similar to those of other post-infectious syndromes such as chronic fatigue syndrome. These data may be the first published data showing distinct rates of long COVID in transgender people, and the large confidence interval around the rate suggests considerable uncertainty in the estimate. However, other research shows that transgender people have lower incomes and poorer health outcomes, which could contribute to greater vulnerability to COVID.

One in five Hispanic adults (20%) said they had ever had a long 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 causes of higher long COVID rates in Hispanic adults, but their higher rates of COVID infection undoubtedly contribute to the difference. No difference is seen in long COVID rates between black and white adults, although black adults experience 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.

Among adults with less than a high school education, 20% report having long COVID, compared to just 12% of adults with a college degree. Pulse data as 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 levels of education and income and lower incomes, so it is likely that rates of long COVID are higher among people with lower incomes and incomes. It is unclear to what extent higher rates of long COVID result from reduced access to healthcare prior to infection, but a study of long COVID rates in the UK found that socio-economic deprivation was a risk factor. Analyzes of future Pulse data, with larger sample sizes, will be helpful in determining if similar trends exist in the United States.

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

Going forward, the long COVID could amplify existing disparities within society. Even before the pandemic, women were more likely to work in low-paying jobs or receive lower pay for similar levels of work than men, and the pandemic has had particularly adverse effects on women’s employment by compared to that of men. Likewise, higher rates of long-term COVID among Hispanic adults may further exacerbate health, employment, and income disparities among this group, which was already hardest hit by the pandemic. Another study found that Latino and Black adults had higher workplace exposure rates, which contributed to higher COVID prevalence — and ultimately long COVID duration. Data from Pulse suggests that the effects of a long COVID — like the effects of the pandemic more broadly — may decline disproportionately among adults who already experience health and employment disparities. Currently, the sample size is too small to analyze differences between certain populations. Future KFF analysis will draw on additional waves of Pulse survey data to further explore group differences that vary by race, ethnicity, income, occupation and other relevant characteristics. .

In releasing two new reports relevant to people with long-term COVID, HHS Secretary Becerra writes, “Long COVID can impair an individual’s ability to work, attend school, participate in community life. and engage in daily activities. Existing research reinforces the urgency of understanding the effects of long COVID on people: a recent study shows that 4 million people could be out of work in the United States due to long COVID. The implications are amplified when you consider that job losses are concentrated among people who already have lower incomes, lower earnings, and additional difficulty accessing health care. Additionally, long-term COVID patients struggle to access disability benefits, which could mitigate some of the financial consequences associated with being unable to work. As new research comes out on long-term COVID, it will be important to improve our understanding of who is most likely affected, what types of treatment hold the most promise, and what social and economic supports can mitigate longer-term consequences. of the long COVID on socio-economic disparities in the United States

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