Socioeconomic inequalities of Long COVID: findings from a population-based survey in the United Kingdom

Abstract

ObjectiveTo estimate the risk of Long COVID by socioeconomic deprivation and to further examine the socioeconomic inequalities in Long COVID by sex and occupational groups.DesignWe analysed data from the COVID-19 Infection Survey conducted by the Office for National Statistics between 26/04/2020 and 31/01/2022. This is the largest and nationally representative survey of COVID-19 in the UK and provides uniquely rich, contemporaneous, and longitudinal data on occupation, health status, COVID-19 exposure, and Long COVID symptoms.SettingCommunity-based longitudinal survey of COVID-19 in the UK.ParticipantsWe included 201,799 participants in our analysis who were aged between 16 and 64 years and had a confirmed SARS-CoV-2 infection.Main outcome measuresWe used multivariable logistic regression models to estimate the risk of Long COVID at least 4 weeks after acute SARS-CoV-2 infection by deciles of index of multiple deprivation (IMD) and adjusted for a range of demographic and spatiotemporal factors. We further examined the modifying effects of socioeconomic deprivation by sex and occupational groups.ResultsA total of 19,315 (9.6%) participants reported having Long COVID symptoms. Compared to the least deprived IMD decile, participants in the most deprived decile had a higher adjusted risk of Long COVID (11.4% vs 8.2%; adjusted OR: 1.45; 95% confidence interval [CI]: 1.33, 1.57). There were particularly significantly higher inequalities (most vs least deprived decile) of Long COVID in healthcare and patient facing roles (aOR: 1.76; 1.27, 2.44), and in the education sector (aOR: 1.62; 1.26, 2.08). The inequality of Long COVID was higher in females (aOR: 1.54; 1.38, 1.71) than males (OR: 1.32; 1.15, 1.51).ConclusionsParticipants living in the most socioeconomically deprived areas had a higher risk of Long COVID. The inequality gap was wider in females and certain public facing occupations (e.g., healthcare and education). These findings will help inform public health policies and interventions in adopting a social justice and health inequality lens.

Patterns and combinations of long-term COVID symptoms in adults and elderly in Southern Brazil: a population-based Sulcovid Study

“…As for the association found for sex, the prevalence of symptoms in females may be higher due to the mechanisms of direct effects of the virus or indirect effects caused by immune responses [31]. Direct effects such as lower production of pro-in ammatory interleukin − 6 (IL-6) after viral infection in women, or indirect effects such as greater psychological stress, poorer sleep quality and greater likelihood of reporting their symptoms [31,32].…”

Cross‐sectional population‐based estimates of a rural‐urban disparity in prevalence of long COVID among Michigan adults with polymerase chain reaction‐confirmed COVID‐19, 2020‐2022

“…We included documented or suspected long COVID risk factors as covariates based on the findings of previous literature 8–23 . We considered a risk factor “documented” if it was consistently found to have an association with long COVID in the current literature.…”

“…Suspected risk factors included race and ethnicity, 10,12,20,21 2 indicators of socioeconomic status (educational attainment, employment status directly prior to COVID‐19 onset), 10,12,22 2 indicators of health care access (health insurance coverage at the time of COVID‐19 onset; whether needed care had been delayed due to socioeconomic or institutional barriers, such as cost, transportation, caregiving, or work responsibilities), 21 dominant SARS‐CoV‐2 variant at the time of COVID‐19 onset, 12,23 and number of pre‐existing conditions 8–11,13,18 . Regarding pre‐existing conditions, MI CReSS respondents were asked whether they had any of the following conditions prior to having COVID‐19: emphysema or chronic obstructive pulmonary disease (COPD), asthma, diabetes, heart disease or other cardiovascular disease, high blood pressure, liver disease, kidney disease, stroke or other cerebrovascular disease, cancer, immunosuppressive condition, autoimmune condition, physical disability, psychological or psychiatric condition, or any other condition.…”

“…The causes and treatment of long COVID are not yet well understood, though prior work has consistently found that older age, female sex, severe acute COVID‐19 illness, and being unvaccinated against COVID‐19 prior to infection are associated with an increased risk of developing long COVID 8–19 . Further, while understudied, there is some evidence of racial, ethnic, and socioeconomic disparities in long COVID 10,20–22 . There is also preliminary evidence that some pre‐existing health conditions 8–11,13,18 and variant of SARS‐CoV‐2, 12,23 the virus that causes COVID‐19, may influence the risk of long COVID 12,23 …”

Barriers to healthcare access and experiences of stigma: Findings from a coproduced Long Covid case‐finding study

“…Little is known about disadvantaged groups' experiences of Long Covid. Some evidence suggests that people living in more deprived communities and who belong to some ethnic minority backgrounds are more likely to experience Long Covid than those living in the least deprived areas or those of White ethnicity 16–18 but conversely may be underrepresented in post‐COVID services 19 . This could suggest fewer people with Long Covid symptoms from these disadvantaged groups are receiving Long Covid care, which has the potential to increase health inequalities.…”