Journal Article

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

Kim, Daniel

2025

Overview

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. Plain Language Summary Long COVID is a long-term health problem in people with a history of likely or confirmed SARS-CoV-2 infection (the virus that causes COVID-19). U.S. Census Bureau data on over 375,000 adults were used to identify risk factors for long COVID and its harmful effects. Nearly one in every seven adults reported a history of long COVID in late 2023, months after the emergency phase of the pandemic was declared over. Those with lower income and who are Hispanic, female, and gay/lesbian or bisexual are at higher risk of long COVID. Long COVID is also linked to higher risks of job loss, financial hardship, and anxiety and depression. Overall, 24 million working-aged adults with long COVID were at risk of these negative outcomes. Lost earnings due to long COVID among working-aged adults totaled $218 billion in 2023. These findings show the important public health and economic consequences of long COVID among Americans. Kim identifies risk factors for long COVID and links long COVID to higher instances of job loss, financial hardship, and anxiety and depressive symptoms. Lost earnings due to long COVID among working-aged adults are estimated to total $218 billion in 2023, indicating long COVID’s substantial public health and economic consequences among Americans.

• Publisher: Nature Publishing Group UK,Springer Nature B.V,Nature Portfolio
• Subject: 692/308/174 / 692/700/478 / Age groups / COVID-19 vaccines / Family income / Gays & lesbians / Gender / Generalized anxiety disorder / Health insurance / Households / Infections / Labor force / Long COVID / Marital status / Medicine / Medicine & Public Health / Mental disorders / Mental health / Polls & surveys / Public health / Sexual orientation / Sociodemographics / Unemployment