A nationwide study of risk factors for long COVID and its economic and mental health consequences in the United States.

Abstract

Background: In the United States, concerns have been increasingly raised over the future public health and economic burden of long COVID including disability and declines in labor force participation. However, only a handful of U.S. studies have explored sociodemographic or socioeconomic characteristics that put people at risk of long COVID or have investigated its economic and mental health sequelae.

Methods: Using repeated cross-sectional data on over 375,000 adults including nearly 50,000 adults with long COVID pooled from U.S. nationally-representative Household Pulse Survey data collected between September and November 2022 and between August and October 2023, I fit age- and gender-adjusted and multivariable modified Poisson regression models to examine multiple sociodemographic and socioeconomic factors as predictors of long COVID. I further estimate the risks of unemployment, financial hardship, and anxiety and depression among working-aged adults and adults with current long COVID symptoms, and estimate the economic burden of lost wages due to long COVID.

Results: Nearly one in seven adults (~35 million) and working-aged adults (~30 million) reported having a history of long COVID by late 2022 and late 2023. In age- and gender-adjusted models and fully-adjusted multivariable models, I find several factors predict long COVID including lower household income, and being Hispanic, female, gay/lesbian or bisexual. I also find having long COVID is linked to higher risks of recent unemployment, financial hardship, and anxiety and depressive symptomatology, with evidence of dose-response relationships.

Conclusions: Overall, an estimated 24 million working-aged adults with long COVID had been or may still be at risk of adverse socioeconomic and mental health outcomes. The lost earnings due to long COVID among working-aged adults are estimated to total $211 billion in 2022 and $218 billion in 2023. These findings highlight the substantial public health and economic implications of long COVID among Americans.