Will Prolonged COVID Increase Existing Inequalities in Health and Employment?

Preliminary data show that as of August 8, 2022, self-reported long-term COVID rates among female, transgender, Hispanic, and non-high school adults were one-quarter to one-third higher than for all adults (Figure 1). In this policy follow-up, we explore how these high long-term COVID rates may exacerbate existing inequalities in health and employment, using new data on long-term COVID from the Household Heart Rate Survey, as reported by the Centers for Disease Control and Prevention (CDC). The heart rate survey is an experimental survey that provides information on how the COVID pandemic is affecting households socially and economically. Its primary advantage is the short turnaround time, but data may not meet all Census Bureau quality standards. In June 2022, the survey began asking questions about the long-term COVID. While these early data provide some important insights into the prevalence of long-term COVID to date, the sample only includes about 150,000 participants, limiting the reliability of the findings and the ability to detect differences between groups. This policy monitoring focuses on characteristics that the CDC has determined are sufficient observations to report differences between groups.

There is no established definition of long-term COVID, but the Pulse survey asked participants if they had any symptoms of COVID lasting more than 3 months, including “tiredness or weakness, difficulty thinking, concentrating, forgetfulness, or memory problems (sometimes called). breathing difficulties or shortness of breath, joint or muscle pain, fast pounding or palpitations (also known as heart palpitations), chest pain, dizziness when standing up, menstrual changes, changes in taste/smell, or and not being able to exercise.” There are several other studies evaluating the socioeconomic effects of long-term COVD, but those that do are consistent with our findings from the Pulse survey.

Household Heart Rate data show that long-term COVID rates are higher for female (18%) and transgender (19%) adults than for males (11%). The difference in rates between men and women has been documented elsewhere: In another study, the prevalence of long-term pre-Omicron COVID-19 was 1.4%-2.2% in adult females in the US compared to only 0.9%-1.7% of adult males. has been estimated. It is unclear what drives the differences in outcomes between women and men, but the patterns are similar to those of other post-infectious syndromes such as chronic fatigue syndrome. These data may be the first published data to show separate long-term COVID rates among transgender people, and the wide confidence interval around this rate indicates significant uncertainty in the estimate. However, other research shows that transgender people have lower earnings and worse health outcomes, which may contribute to greater vulnerability to COVID.

One in five (20%) Hispanic adults reported having long-term COVID, compared to less than 15% of White, Black, or Asian adults. Data are not reported separately for Native Americans and Alaska Natives or Hawaiian Indians and other Pacific Islanders. There are no studies evaluating the reasons for the higher rates of long-term COVID among Hispanic adults, but higher rates of COVID infection undoubtedly add to the difference. Although Black adults experienced higher age-adjusted rates of COVID infection and death, no differences in long-term COVID rates were observed between Black and White adults. More research is needed to better understand the racial and ethnic patterns of long-term COVID rates and their relationship to COVID cases and deaths.

20% of adults with a high school diploma report having long-term COVID-19 disease, compared to only 12% of adults with a college degree. Pulse data reported by the CDC does not show the distribution of long-term COVID among people based on income or employment outcomes, but there is a well-established association between higher education levels and lower earnings and income, so rates are likely to be high. Long-term COVID-19 is higher among people with lower earnings and incomes. It is unclear to what extent higher rates of prolonged COVID-19 are due to reduced access to healthcare prior to infection, but a study of prolonged COVID rates in the UK has found that socioeconomic deprivation is a risk factor. Future analyzes of Heart Rate data with larger sample sizes will be helpful in determining whether similar patterns exist in the US.

In addition to health, it can worsen employment outcomes, as long-term COVID disproportionately affects people of working age. Consistent with other studies, the Pulse data show that long-term rates of COVID-19 are highest among adults during the working years. (The very low rates of long-term COVID among people over 60 are likely to reflect the higher mortality from COVID in this population.) Current research shows that long-term COVID significantly affects people’s ability to work. While it’s still too early to know how long-term these effects might be, a recent study found that people who experienced COVID-related layoffs for a week were significantly less likely to work than similar employees who didn’t miss a week. work for health-related reasons. A recent analysis of survey data revealed that 26% of people with long-term COVID reported that it had an impact on their employment.

Looking ahead, prolonged COVID may increase existing inequalities in society. Even before the pandemic, women were more likely to work in low-paying jobs or be paid less for jobs of a similar level to men, and the pandemic had particularly deleterious effects on women’s employment compared to men’s employment. Similarly, higher long-term COVID rates among Hispanic adults could exacerbate health, employment and income inequalities among this group already more affected by the pandemic. Another study found that Latino and Black adults have higher workplace exposure rates, which contributes to a higher prevalence of COVID and ultimately long-term COVID. Pulse data shows that the impacts of long-term COVID – such as 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 some populations. Future KFF analysis will leverage additional waves of Pulse survey data to further explore differences between groups that differ by race, ethnicity, income, employment, and other relevant characteristics.

“Prolonged COVID may interfere with an individual’s ability to work, attend school, participate in community life, and participate in daily activities,” writes HHS Secretary Becerra, in issuing two new reports on people with long-term COVID. Current research reinforces the urgency of understanding the effects of prolonged COVID on people: A recent study shows that 4 million people in the US may be unemployed as a result of prolonged COVID. The consequences are even greater given that job losses are already concentrated among those with lower incomes, lower earnings and additional difficulties in accessing health care. Also, long-term COVID patients are struggling to access disability benefits that may alleviate some of the financial consequences associated with being unable to work. affected, what types of treatments are most promising, and what social and economic supports may alleviate the long-term consequences of COVID-19 on socioeconomic inequalities in the United States.

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