BACKGROUND: While racial disparities in COVID-19-related outcomes and the role of social determinants of health (SDOH) are well documented, few studies have examined how race/ethnicity and SDOH jointly influence the occurrence of long COVID (LC) and the variation in its primary symptoms.
METHODS: Using 2022 Behavioral Risk Factor Surveillance System data, we estimated LC prevalence across racial/ethnic groups and calculated a SDOH summary score (0-10), with higher scores indicating greater exposure to adverse SDOH. Logistic regressions were employed to assess associations of SDOH and race/ethnicity with the presence of LC and primary LC symptoms. Adjusted average marginal effects (AMEs) were calculated to quantify differences in LC prevalence across SDOH levels and racial/ethnic groups.
RESULTS: Among 92,109 respondents who tested positive for COVID-19, 20,393 (22.14%) reported experiencing LC. Compared to non-Hispanic Whites, non-Hispanic Black (adjusted odds ratio [aOR] = 0.82, 95% confidence interval [CI]: 0.668-0.999) and Asian (aOR = 0.58, 95% CI:0.370.89) individuals were less likely to report LC. Higher SDOH scores were associated with increased LC risk, with aOR (95%CI) being 1.47(1.28-1.69), 1.56(1.29-1.87), 2.26(1.80-2.83), and 3.21(2.65-3.89) for scores of 1, 2, 3, and ≥ 4, respectively, compared with a score of 0. Compared to White individuals, Black and Hispanic respondents had higher odds of reporting joint/muscle pain (aOR = 3.03, 95%CI: 1.49-6.18, and OR = 3.11, 95%CI: 1.84-5.25, respectively). Higher SDOH scores were linked to increased risk of joint/muscle pain, dizziness, and post-exertional symptoms, but decreased risk of taste/smell loss.
CONCLUSION: Greater SDOH burden was associated with higher LC prevalence and variation in primary symptoms, with effects differing across racial/ethnic groups. These findings highlight the importance of addressing social conditions in efforts to reduce LC disparities.
Long Covid