Will long-term COVID-19 exacerbate existing disparities in health and employment?

Early data show that as of August 8, 2022, self-reported long-term COVID rates are one-quarter to one-third higher among adults who are female, transgender, Hispanic, and without a high school diploma 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 Dust Survey, as reported by the Centers for Control and Disease Prevention (CDC). 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 the short response 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-term COVID. Although these early data provide some important insights into the prevalence of long-term COVID, the sample so far only includes about 150,000 respondents, limiting the reliability of the findings and the ability to detect differences between groups. This policy surveillance 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 prolonged COVID, but the Pulse survey asked respondents if they had any symptoms of COVID that lasted more than 3 months, including “tiredness or fatigue, difficulty thinking, concentrating, forgetfulness, or memory problems (sometimes referred to as “brain fog”), difficulty breathing or shortness of breath, joint or muscle pain, fast heartbeat or pounding heart (also known as heart palpitations), chest pain, dizziness upon standing, menstrual changes, changes in taste/smell, or inability to exercise.” There are few other studies that assess the socioeconomic implications of long COVD, but those that do are consistent with our findings of the Pulse survey.

Household Pulse data shows that rates of long-term COVID are higher for adults who are female (18%) and transgender (19%) compared to males (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%-2.2% of adult women in the US in compared to only 0.9%-1.7% of adult men. It is not clear what is driving the differences in outcomes between women and men, but the patterns are similar to other post-infectious syndromes such as chronic fatigue syndrome. These data may be the first published data to show separate rates of long COVID among 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 (20%) Hispanic adults reported having had COVID for a long time compared to less than 15% of white, black, or Asian adults. Data were not reported separately for American Indians and Alaska Natives or Hawaiians and other Pacific Islanders. There are no studies assessing the causes of the higher long-term rates of COVID among Hispanic adults, but their higher rates of COVID infection certainly contribute to the difference. No differences in rates of long-term COVID are observed between white and black adults, although black adults experience higher age-adjusted rates of infection and death from COVID. 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 degree, 20% report having had COVID for a long time, compared to only 12% of adults with a college degree. 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 education levels and income and lower income, so It is likely that long-term COVID rates are higher among people with lower incomes and lower incomes. It is not clear to what extent higher long-term rates of COVID result from reduced access to health care before infection, but a study of long-term rates of COVID in the United Kingdom found that socioeconomic deprivation was a risk factor. Future analyzes of dust data, with larger sample sizes, will be useful in determining whether similar patterns exist in the U.S.

Because COVID-19 disproportionately affects working-age people, it can worsen work outcomes in addition to health. Consistent with other studies, Pulse data shows that rates of long-term COVID are highest among adults in their working years. (The very low rates of long COVID among people over 60 are likely to reflect higher mortality from COVID among this population.) Current research shows that long COVID significantly affects people’s ability to work. While it’s too early to tell how long-term these effects may be, a recent study found that people who experienced a week’s worth of work absences related to COVID-19 were significantly less likely to work than those who similar workers who did not miss 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.

Looking ahead, long-term COVID could amplify existing disparities within society. Even before the pandemic, women were more likely to work in low-wage jobs or to be paid less for similar levels of work than men, and the pandemic had particularly damaging effects on female employment in relationship with that of men. Similarly, higher rates of long-term COVID among Hispanic adults may further exacerbate disparities in health, employment, and income among this group, which was already hardest hit by the pandemic. Another study found that Latino and black adults had higher rates of workplace exposure, which contributed to a higher prevalence of COVID and ultimately to COVID-19. The Pulse data suggest that the effects of long-term COVID, like the effects of the broader pandemic, may fall disproportionately among adults already experiencing disparities in 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 data from the Pulse survey to further explore differences between groups that vary by race, ethnicity, income, occupation, and other relevant characteristics.

In releasing two new reports relevant to those with prolonged COVID, HHS Secretary Becerra writes: “Long-term COVID can hinder a person’s ability to work, attend school, participate in community life, and participate in everyday activities. Existing research reinforces the urgency of understanding the effects of prolonged COVID-19 on people: a recent study shows that 4 million people may be out of work in the US as a result of prolonged COVID-19. The implications are magnified when one considers that job losses are concentrated among people who already have lower incomes, lower incomes, and additional challenges accessing health care. In addition, long-term COVID patients have difficulty accessing disability benefits, which could mitigate some of the financial consequences associated with being unable to work As new research on long-term COVID emerges, it will be important to improve our understanding of who is most likely to be. affected, what types of treatment are most promising, and what social and economic supports can mitigate the long-term consequences of COVID-19 on socioeconomic disparities in the US

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