Will the long-term COVID worsen existing inequalities in health and employment?

Early data show that as of August 8, 2022, the self-reported rate of long-term COVID is one-quarter 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 those higher long-term COVID rates could exacerbate existing health and employment inequalities using new long-term COVID data from the Household Pulse Survey, as reported from the Centers for Disease Control and Prevention (CDC). The Pulse survey is an experimental survey that provides information on how the COVID pandemic is affecting families from a social and economic perspective. Its main advantage is the short turnaround 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 long-term prevalence of 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 observation focuses on characteristics for which CDC has determined that there are enough observations to report differences between groups.

There is no well-defined definition of prolonged COVID, but the Pulse survey asked respondents if they had any symptoms of COVID that lasted for more than 3 months, including “fatigue or tiredness, difficulty thinking, concentrating, forgetfulness or memory problems (sometimes referred to as “brain fog”), difficulty breathing or shortness of breath, joint or muscle pain, fast heartbeat or palpitations (also known as palpitations), chest pain, lightheadedness , menstrual changes, changes in taste/smell, or inability to exercise.” There are few other studies evaluating the socioeconomic implications 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%) compared to males (11%). The difference in rates between men and women has been documented elsewhere: Another study estimated the long-term pre-Omicron COVID prevalence to be 1.4%-2.2% of US adult females compared to only 0.9%-1.7% of male adults. It is unclear what drives the differences in outcomes between women and men, but the patterns are similar to those of other postinfection syndromes, such as chronic fatigue syndrome. These data may be the first published data showing specific rates of long-term COVID among people who are transgender, and the large confidence interval around the rate suggests considerable uncertainty in the estimate. However, other studies show that transgender people have lower incomes and poorer health outcomes, which may 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 the higher rates of COVID in Hispanic adults, but their 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 Black adults experiencing higher age-adjusted rates of COVID infection and death. More research is needed to better understand the racial and ethnic patterns of long-term rates of COVID and their association with COVID cases and deaths.

Of adults with less than a high school diploma, 20% report having long-standing COVID, compared to only 12% of adults with a college degree. The Pulse data as reported by the CDC does not show the longitudinal distribution of COVID among people based on income or employment outcomes, but there is a well-established relationship between higher levels of education and lower earnings and income, so it is likely that rates of prolonged COVID are higher in people with lower incomes and incomes. It is unclear to what extent higher long-term rates of 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 socio-deprivation economic was a risk factor. Future analyzes of the Pulse data, with larger sample sizes, will be useful in determining whether similar patterns exist in the US

Because long-term COVID disproportionately affects working-age people, it can 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 likely that the very low rates of prolonged COVID among people over 60 reflect higher mortality from COVID among this population.) Current research shows that prolonged COVID significantly affects fitness of people to work. Although it is too early to know how long-term these effects may be, a recent study found that people who experienced week-long, COVID-related absences from work were significantly less likely to work than similar workers who did not miss a week. week. of 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 may reinforce existing inequalities within society. Even before the pandemic, women were more likely to work in low-wage jobs or receive lower wages for similar levels of work than men, and the pandemic had particularly damaging effects on women’s employment relative to men. Similarly, higher rates of prolonged COVID among Hispanic adults could further exacerbate health, employment, and income disparities among this group, which were already hardest hit by the pandemic. Another study found that Latino and black adults had higher levels of workplace exposure, which contributed to higher prevalence of COVID—and ultimately to prolonged COVID. Pulse data suggest that the effects of prolonged COVID—like the effects of the pandemic more broadly—may fall disproportionately among adults who already experience disparities in health and employment outcomes. Currently, the sample size is too small to analyze differences between several populations. Future KFF analysis will use additional waves of Pulse survey data to further explore differences between groups that vary by race, ethnicity, income, employment, and other relevant characteristics.

In releasing two new reports related to those with long-term COVID, HHS Secretary Becerra writes, “Long-term COVID can impede an individual’s ability to work, attend school, participate in community life and to engage in daily activities.” Existing research reinforces the urgency to understand the effects of prolonged COVID on people: A recent study shows that 4 million people could be out of work in the US as a result of a prolonged COVID-19. The implications are magnified when one considers that job losses are concentrated among people who already have lower incomes, lower incomes, and additional challenges in accessing health care. Further, patients with COVID-19 are struggling to access disability benefits, which can mitigate some of the financial consequences associated with not being able to work As new research emerges regarding long-term COVID, it will be important to improve our understanding of who is most likely to be affected, what types of treatments are most promising, and what social and economic supports can mitigate the long-term consequences of long-term COVID on socioeconomic disparities in the US

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