Journal article
Social Determinants of Health and Risk for Long COVID in the US RECOVER-Adult Cohort
Annals of internal medicine, Vol.178(9), pp.1287-1297
09/01/2025
DOI: 10.7326/ANNALS-24-01971
PMID: 40720834
Abstract
Background: Social determinants of health (SDoH) contribute to disparities in SARS-CoV-2 infection, but their associations with long COVID are unknown.Objective: To determine associations between SDoH at the time of SARS-CoV-2 infection and risk for long COVID.Design: Prospective observational cohort study.Setting: 33 states plus Washington, DC, and Puerto Rico.Participants: Adults (aged >= 18 years) enrolled in RECOVER-Adult (Researching COVID to Enhance Recovery) between October 2021 and November 2023 who were within 30 days of SARS-CoV-2 infection; completed baseline SDoH, comorbidity, and pregnancy questionnaires; and were followed prospectively.Measurements: Social risk factors from SDoH baseline questionnaires, ZIP code poverty and household crowding measures, and a weighted score of 11 or higher on the Long COVID Research Index 6 months after infection.Results: Among 3787 participants, 418 (11%) developed long COVID. After adjustment for demographic characteristics, pregnancy, disability, comorbidities, SARS-CoV-2 severity, and vaccinations, financial hardship (adjusted marginal risk ratio [ARR], 2.36 [95% CI, 1.97 to 2.91]), food insecurity (ARR, 2.36 [CI, 1.83 to 2.98]), less than a college education (ARR, 1.60 [CI, 1.30 to 1.97]), experiences of medical discrimination (ARR, 2.37 [CI, 1.94 to 2.83]), skipped medical care due to cost (ARR, 2.87 [CI, 2.22 to 3.70]), and lack of social support (ARR, 1.79 [CI, 1.50 to 2.17]) were associated with increased risk for long COVID. Living in ZIP codes with the highest (vs. lowest) household crowding was also associated with greater risk (ARR, 1.36 [CI, 1.05 to 1.71]).Limitation: Selection bias may influence observed associations and generalizability.Conclusion: Participants with social risk factors at the time of SARS-CoV-2 infection had greater risk for subsequent long COVID than those without. Future studies should determine whether social risk factor interventions mitigate long-term effects of SARS-CoV-2 infection.Primary Funding Source: National Institutes of Health.
Details
- Title: Subtitle
- Social Determinants of Health and Risk for Long COVID in the US RECOVER-Adult Cohort
- Creators
- Candace H. Feldman - Brigham and Women's HospitalLeah Santacroce - Brigham and Women's HospitalIngrid V. Bassett - Harvard UniversityTanayott Thaweethai - Harvard UniversityRadica Alicic - University of WashingtonRachel Atchley-Challenner - Massachusetts Gen Hosp, Biostat, Boston, MA USAAlicia Chung - New York UniversityMark P. Goldberg - The University of Texas at San Antonio Health Science CenterCarol R. Horowitz - Icahn School of Medicine at Mount SinaiKaren B. Jacobson - Stanford MedicineJ. Daniel Kelly - University of California, San FranciscoStacey Knight - Intermountain HealthcareKaren Lutrick - University of ArizonaPraveen Mudumbi - New York UniversitySairam Parthasarathy - University of ArizonaHeather Prendergast - University of ChicagoYuri Quintana - Beth Israel Deaconess Medical CenterNasser Sharareh - University of UtahJudd Shellito - Louisiana State University Health Sciences Center New OrleansZaki A. Sherif - Howard UniversityBrittany D. Taylor - American Heart AssociationEmily Taylor - Solve ME, Los Angeles, CA USAJoel Tsevat - The University of Texas at San Antonio Health Science CenterZanthia Wiley - Emory UniversityNatasha J. Williams - New York UniversityLynn Yee - Northwestern UniversityLisa Aponte-Soto - Illinois Res Network ILLInet, Chicago, IL USAJhony Baissary - Case Western Reserve UniversityJasmine Berry - Emory UniversityAlexander W. Charney - Icahn School of Medicine at Mount SinaiMaged M. Costantine - The Ohio State UniversityAlexandria M. Duven - Swedish Medical CenterNathaniel Erdmann - University of Alabama at BirminghamKacey C. Ernst - University of ArizonaElen M. Feuerriegel - University of Colorado AnschutzValerie J. Flaherman - University of California, San FranciscoMinjoung Go - Stanford MedicineKellie Hawkins - Denver Health Medical CenterVanessa Jacoby - University of California, San FranciscoJanice John - Cambridge Health AllianceSara Kelly - Peoria campus of the University of Illinois SystemElijah Kindred - Illinois Res Network ILLInet, Chicago, IL USAAdeyinka Laiyemo - Howard UniversityEmily B. Levitan - University of Alabama at BirminghamBruce D. Levy - Brigham and Women's HospitalJennifer K. Logue - University of WashingtonJai G. Marathe - Boston UniversityJeffrey N. Martin - University of California, San FranciscoGrace A. Mccomsey - Case Western Reserve UniversityTorri D. Metz - University of UtahTony Minor - MetroHealthAoyjai P. Montgomery - University of Alabama at BirminghamJanet M. Mullington - Beth Israel Deaconess Medical CenterIgho Ofotokun - Emory UniversityMegumi J. Okumura - University of California, San FranciscoMichael J. Peluso - University of California, San FranciscoKristen Pogreba-Brown - University of ArizonaHengameh Raissy - University of New MexicoJohana M. Rosas - NYU Langone HealthUpinder Singh - Stanford MedicineTimothy Vanwagoner - University of Oklahoma Health Sciences CenterCheryl R. Clark - Brigham and Women's HospitalElizabeth W. Karlson - Brigham and Women's Hospital
- Resource Type
- Journal article
- Publication Details
- Annals of internal medicine, Vol.178(9), pp.1287-1297
- DOI
- 10.7326/ANNALS-24-01971
- PMID
- 40720834
- NLM abbreviation
- Ann Intern Med
- ISSN
- 0003-4819
- eISSN
- 1539-3704
- Publisher
- Amer Coll Physicians
- Number of pages
- 12
- Grant note
- OTA OT2HL161841; OT2HL161847; OT2HL156812 / National Institutes of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA
- Language
- English
- Date published
- 09/01/2025
- Academic Unit
- Internal Medicine
- Record Identifier
- 9985244561902771
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