Preventive medicine reportsApr 20, 2026

Differences in Long COVID diagnosis by sex, race and ethnicity, and insurance type

Updated Jun 27, 2026

Abstract

Essence

Long COVID diagnoses in one health system appeared skewed toward female, non-Hispanic White, and privately insured patients.

Evidence

This electronic health record cross-sectional comparison examined Advocate Health-Midwest COVID-19 and Long COVID documentation from March 1, 2020, to November 1, 2023, by sex, race/ethnicity, insurance type, and combined demographic groups.

Caveat

Diagnosis patterns may reflect who seeks and obtains care rather than true Long COVID prevalence, especially for patients facing multiple barriers to diagnosis.

Simplified

OBJECTIVE: Our study explored Long COVID diagnostic inequity by comparing the demographic profile of patients diagnosed with Long COVID to patients diagnosed with COVID-19.

METHODS: Using electronic health record data from Advocate Health-Midwest between March 1, 2020, to November 1, 2023, we compared the proportion of all patients with documentation of Long COVID versus COVID-19 by race/ethnicity, sex, insurance type, and varying combinations of these characteristics.

RESULTS: Relative to COVID-19, a greater proportion of patients diagnosed with Long COVID were female (63.7% vs. 58.0%), non-Hispanic (NH) White (66.4% vs 62.9%), or covered by private insurance (53.8% vs 51.3%), and a lower proportion were Hispanic (12.1% vs. 14.3%) or covered by Medicaid (11.9% vs. 14.3%). Among patients with Medicaid, NH Black patients were underrepresented by 5.4 percentage points in the Long COVID sample vs. COVID-19 (25.2% vs. 30.6%), while NH White patients were overrepresented by 6.7 percentage points in the Long COVID sample compared to COVID-19 (48.2% vs. 41.5%).

CONCLUSIONS: Long COVID diagnostic estimates may be skewed towards patients that are more willing and able to seek care, while patients who experience multiple forms of disadvantage may be at risk for underdiagnosis due to compounding barriers to diagnosis.

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Differences in Long COVID diagnosis by sex, race and ethnicity, and insurance type

Abstract

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