Will long-term COVID exacerbate existing health and employment inequalities?

Early data show that as of August 8, 2022, rates of self-reported long-term COVID are one-fourth 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 long-term COVID could exacerbate existing health and employment disparities, using new data on long-term COVID from the Family Pulse Survey, as reported by the Centers for Disease Control and Prevention ( CDC). The Pulse survey is a pilot survey that provides insights into how the COVID pandemic is affecting households socially and economically. Its main advantage is its short processing time, but the data may not meet all Census Bureau quality standards. In June 2022, the survey began asking questions about long-term COVID. While these early data provide some important insights into the prevalence of long-term COVID, to date, the sample includes only about 150,000 respondents, which limits the reliability of the findings and the ability to detect differences between groups. This policy monitoring focuses on characteristics for which CDC has determined that there are enough observations to report differences between groups.

There is no well-established definition of long-term COVID, but the Pulse survey asked respondents if they had had symptoms of COVID that lasted more than 3 months, such as “tiredness or tiredness, difficulty thinking, concentrating, forgetfulness, or memory problems (sometimes referred to as “fog of the brain”), difficulty breathing or shortness of breath, joint or muscle pain, fast or rapid heartbeat (also known as palpitations), chest pain, dizziness when standing, changes in periods, changes in taste /smell, or inability to exercise”. There are few other studies that assess the socioeconomic impact of long-term COVD, but those that do are consistent with our findings from the Pulse survey.

Household Pulse data show that rates of long-term COVID are higher for adults who are female (18%) and transgender (19%) than for males (11%). The difference in rates between men and women has been documented elsewhere: Another study estimated that the prevalence of long-term COVID pre-Omicron was 1.4%-2.2% of adult US women compared to only 0.9%-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-infection syndromes, such as chronic fatigue syndrome. These data may be the first published data showing separate rates of long-term COVID among people who are transgender, and the large confidence interval around the rate suggests significant uncertainty in the estimate. However, other research shows that transgender people have lower earnings and worse health outcomes, which could contribute to greater vulnerability to COVID.

One in five (20%) Hispanic adults reported ever having long-term 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-term rates of COVID among Hispanic adults, but higher rates of COVID infection undoubtedly contribute to the difference. No differences in long-term COVID rates are observed between black and white adults, despite the fact that black adults experience higher age-adjusted rates of infection and death from COVID-19. More research is needed to better understand racial and ethnic patterns of long-term COVID rates and their relationship to COVID cases and deaths.

Of adults with less than a high school diploma, 20% report having long-term COVID, compared to only 12% of adults with a college degree. The Pulse data, as 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 wages and income, so it is possible that rates of long-term COVID are higher among people with lower earnings and incomes. It is unclear to what extent the higher rates of long-term COVID result from reduced access to health care prior to infection, but a study of long-term rates of COVID in the United Kingdom found that socioeconomic deprivation was a risk factor. Analyzes of future Pulse data, with larger sample sizes, will be useful 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, Pulse data shows that rates of long-term COVID are highest among adults in their working years. (It is possible that the very low rates of long-term COVID in people over 60 reflect higher mortality from COVID in this population.) Current research shows that long-term 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 experienced a week-long absence from work related to COVID were significantly less likely to work compared to similar workers who did not. they missed a week. work for health reasons. And a recent analysis of survey data found that 26% of people with long-term COVID reported it had affected their employment.

Looking ahead, prolonged COVID could reinforce existing inequalities in society. Even before the pandemic, women were more likely to work in low-wage jobs or receive lower pay for similar levels of work than men, and the pandemic had a particularly harmful effect on women’s employment relative to men’s. 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 rates of workplace exposure, which contributed to the higher prevalence of COVID—and ultimately to prolonged COVID-19. The Pulse data suggest that the effects of long-term COVID—like the effects of the pandemic more broadly—may fall disproportionately among adults who already face disparities in health and employment outcomes. Currently, the sample size is too small to analyze differences between certain populations. Future KFF analysis will leverage additional waves of Pulse survey data to further explore differences among groups that differ by race, ethnicity, income, employment, and other relevant characteristics.

In releasing two new reports related to people with long-term COVID, HHS Secretary Becerra writes, “Long-term COVID can hinder a person’s ability to work, go to school, participate in community life, and participate in daily activities.” Existing research reinforces the urgent need to understand the effects of long-term COVID on people: A recent study suggests that 4 million people may be unemployed in the US as a result of long-term COVID. The effects are magnified when you consider that job losses are concentrated among people who already have lower incomes, lower wages and additional challenges in accessing health care. In addition, patients with COVID-19 have long struggled to access disability benefits, which could mitigate some of the financial consequences associated with not being able to work As new research on long-term COVID is released, 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 may mitigate the long-term consequences of long-term COVID on socioeconomic disparities in the US

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