State and Metropolitan Area Disparities in Long COVID-19 and Related Symptoms among US Adults, June-October 2022

Abstract

Background: Little research exists on sociodemographic and geographic inequalities in Long COVID, defined as COVID-19 symptoms lasting 3 months or longer. Using the latest nationally representative data, we examine geographic disparities in prevalence of Long COVID and severe COVID symptoms among United States (US) adults aged ≥18 years. Methods: We analyzed five consecutive rounds of the US Census Bureau’s Household Pulse Survey from June 1 to October 17, 2022 (N=108,064). Using multivariable logistic regression and health disparity indices, we modeled disparities in Long COVID and severe COVID symptoms by state and metropolitan area, controlling for race/ethnicity, socioeconomic status, health insurance, and other demographic characteristics. Results: During June–October 2022, an estimated 35.4 million or 32.2% of COVID patients in the US reported developing Long COVID; and 15.2 million or 13.8% of COVID patients reported experiencing severe COVID symptoms. The prevalence of Long COVID ranged from 24.0% in the District of Columbia (DC), 25.4% in Hawaii to 39.2% in Alabama, 39.9% in Wyoming, and 43.6% in West Virginia. Adjusted for covariates, adults with COVID-19 diagnosis in Alabama, Wyoming, and West Virginia had 48-178% higher adjusted odds of developing Long COVID than their counterparts in DC. Adults with COVID-19 diagnosis in Alabama, Arkansas, Colorado, Iowa, Kentucky, Mississippi, Montana, North Dakota, South Dakota, Texas, Utah, Virginia, Wyoming, and West Virginia had 2.0-2.5 times higher adjusted odds of experiencing severe COVID symptoms than their counterparts in Vermont. Large disparities in prevalence of Long COVID and severe COVID symptoms existed among the 15 largest metropolitan areas of the US, with the prevalence of Long COVID ranging from 21.9% in San Francisco to 38.0% in Riverside, California. Socioeconomic, demographic and health insurance characteristics explained 34% of the state-level disparity and 45% of the metropolitanarea disparity in Long COVID prevalence. Conclusion and Implications for Translation: Marked geographic disparities existed, with COVID patients/survivors in the Southeast, Southwest, and Northern Plains states being at substantially higher risks of developing Long COVID and severe COVID symptoms. Equitable access to care and support services among patients with Long COVID is critical to reducing inequities in COVID-related health outcomes.