Dr. Candace Feldman is a rheumatologist and assistant professor of medicine at Harvard University. She specializes in collecting and analyzing data to improve health care for disadvantaged communities. Dr. Feldman recently collaborated with a stellar group of health care providers, researchers, and community leaders—including Solve’s CEO, Emily Taylor—to study how social factors affect the risk of getting Long COVID.
It is known that people’s demographics and health factors affect their risk of getting Long COVID. For example, the risk of Long COVID is greater for women than for men, and greater for people with cardiovascular disease or diabetes than for people without.
But how social factors affect the risk for Long COVID was not well understood. Social factors are the conditions in which people live: their access to education; access to health care; economic means; level of community support; and neighborhood disadvantage (e.g., neighborhood deprivation or crowdedness). Studying almost 4,000 adults participating in the RECOVER-Adult cohort, the researchers here asked how social factors affect Long COVID risk.
They found all assessed social factors significantly affected the risk of developing Long COVID. People who skipped medical care because they could not afford it were almost three times as likely to develop Long COVID as people who did not. People with either financial or food hardships were more than twice as likely to develop Long COVID as people without these hardships.
People who experienced medical discrimination or who lost insurance during the pandemic were more than twice as likely to develop Long COVID as people who did not. And people with poor social support were almost twice as likely to develop Long COVID as people with such support.
The greater the social burdens on people, the greater their risk for developing Long COVID (and Blacks and Hispanics had substantially more social burdens than Whites). For example, people with at least two health care access challenges (e.g., experiencing medical discrimination, being uninsured or on Medicaid, or skipping care because of cost) were over four times as likely to develop Long COVID as people with no health care access challenges. And people with at least three economic challenges (e.g., financial, food, or housing instability) were over three times as likely to develop Long COVID as people with no such challenges.
The authors noted some limitations to this study. For example, about three-quarters of participants had college degrees, which is substantially higher than the fraction of US adults with college-level education. This imbalance may have biased estimates of how education access affects risk for Long COVID.
Also, the researchers used zip codes to estimate neighborhood disadvantage. However, levels of deprivation can vary among neighborhoods within a zip code, potentially affecting these results.
Still, this large study of thousands of adults in the US strongly suggests that balancing economic health, education access, health care access, neighborhood resources, and social support, would substantially reduce the chances of developing Long COVID for some communities.
Read “Social Determinants of Health and Risk for Long COVID in the U.S. RECOVER-Adult Cohort” in Annals of Internal Medicine here.