Will Long COVID Exacerbate Existing Disparities in Health and Employment?

Early data show that as of August 8, 2022, rates of self-reported long COVID are one quarter to one third higher among adults who are female, transgender, Hispanic, and without a high-school degree than they are among all adults (Figure 1). In this policy watch, we explore how those higher rates of long COVID could exacerbate existing disparities in health and employment using new data on long COVID from the Household Pulse Survey, as reported by the Centers for Disease Control and Prevention (CDC). The Pulse survey is an experimental survey providing information about how the COVID pandemic is affecting households from social and economic perspectives. Its primary advantage is the short turn-around time, but the data may not meet all Census Bureau quality standards. In June 2022, the survey began asking questions about long COVID. While these early data provide some important insights into the prevalence of long COVID, to date, the sample only includes about 150,000 respondents, which limits the reliability of the findings and the ability to detect differences between groups. This policy watch focuses on characteristics for which the CDC has determined there are enough observations to report differences between groups.

There is no well-established definition of long COVID, but the Pulse survey asked respondents whether they had any COVID symptoms that lasted for longer than 3 months, including “tiredness or fatigue, difficulty thinking, concentrating, forgetfulness, or memory problems (sometimes referred to as “brain fog”), difficulty breathing or shortness of breath, joint or muscle pain, fast-beating or pounding heart (also known as heart palpitations), chest pain, dizziness on standing, menstrual changes, changes to taste/smell, or inability to exercise.” There are few other studies that evaluate the socioeconomic implications of long COVD, but those that do are consistent with our findings from the Pulse survey.

The Household Pulse data show that rates of long COVID are higher for adults who are female (18%) and transgender (19%) relative to males (11%). The difference in rates between men and women has been documented elsewhere: Another study estimated the prevalence of long COVID pre-Omicron was 1.4%-2.2% of adult females in the U.S. compared with only 0.9%-1.7% of adult males. It is unclear what is driving the differences in outcomes between women and men, but patterns are similar to that of other post-infection syndromes such as chronic fatigue syndrome. These data may be the first published data showing separate rates of long COVID among people who are transgender, and the large confidence interval around the rate suggests considerable uncertainty in the estimate. However, other research shows that transgender people have lower earnings and poorer health outcomes, which could contribute to greater vulnerability to COVID.

One in five (20%) Hispanic adults reported ever having long COVID compared with less than 15% of White, Black, or Asian adults. Data were not separately reported for American Indian and Alaska Native or Native Hawaiian and other Pacific Islander people. There are not studies evaluating the causes of higher long COVID rates among Hispanic adults, but their higher rates of COVID infection undoubtedly contribute to the difference. No differences are observed in rates of long COVID 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 COVID rates and their relationship to COVID cases and deaths.

Of adults with less than a high-school diploma, 20% report having long COVID, compared with only 12% of adults with a college degree. The Pulse data as reported by the CDC do not show the distribution of long 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 long COVID are higher among people with lower earnings and incomes. It is unclear to what extent higher rates of long COVID result from reduced access to health care prior to infection, but a study of long COVID rates in the United Kingdom found socioeconomic deprivation was a risk factor. Analyses of future Pulse data, with larger sample sizes, will be useful in determining whether similar patterns exist in the U.S.

Because long COVID disproportionately affects people of working age, it may exacerbate employment outcomes, in addition to health. Consistent with other studies, the Pulse data show that rates of long COVID are highest among adults in their working years. (It is likely that the very low rates of long COVID among people over age 60 reflect higher mortality from COVID among this population.) Current research shows that long COVID significantly affects people’s ability to work. Although it is too early to know how long-term those effects may be, a recent study found that people who experienced week-long, COVID-related absences from work were significantly less likely to be working than similar workers who did not miss a week of work for health-related reasons. And a recent analysis of survey data found that 26% of people with long COVID reported that it had affected their employment.

Looking ahead, long COVID could amplify existing disparities within society. Even before the pandemic, females were more likely to work in low-wage jobs or receive lower pay for similar levels of work as males, and the pandemic had particularly harmful effects on female’s employment relative to male’s. Similarly, higher rates of long COVID among Hispanic adults may further exacerbate health, employment, and income disparities among this group, who were already harder hit by the pandemic. Another study found that Latino and Black adults had higher rates of workplace exposure, which contributed to higher COVID prevalence—and eventually long COVID. The Pulse data suggest that the effects of long 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 among some populations. Future KFF analysis will leverage additional waves of Pulse survey data to further explore differences among groups that vary by race, ethnicity, income, employment, and other pertinent characteristics.

In releasing two new reports relevant to those with long COVID, HHS Secretary Becerra writes, “Long COVID can hinder an individual’s ability to work, attend school, participate in community life, and engage in everyday activities.” Existing research reinforces the urgency of understanding the effects of long COVID on people: A recent study shows that 4 million people may be out-of-work in the U.S. as a result of long COVID. The implications are magnified when one considers that the employment losses are concentrated among people who already have lower incomes, lower earnings, and additional challenges in accessing health care. Further, long COVID patients are struggling to access disability benefits, which could mitigate some of the financial consequences associated with an inability to work As new research comes out on long COVID, it will be important to improve our understanding of who is most likely to be affected, what types of treatment are most promising, and what social and economic supports may mitigate the longer-term consequences of long COVID on socioeconomic disparities in the U.S.