Associations Between Social Vulnerability and Long COVID: A Nationwide U.S. Study Among Symptomatic Outpatient
Author(s)
Manuela Di Fusco, Ph.D.1, Laura Lupton, MD, MHA2, Alon Yehoshua, PharmD1, Meghan Gavaghan, MPH1, Laura Puzniak, PhD1, Santiago Lopez, MD1, Joseph C. Cappelleri, MPH, MS, PhD1, Xiaowu Sun, PhD2;
1Pfizer Inc., New York, NY, USA, 2CVS Health, Woonsocket, RI, USA
1Pfizer Inc., New York, NY, USA, 2CVS Health, Woonsocket, RI, USA
Presentation Documents
OBJECTIVES: COVID-19 health disparities associated with acute SARS-CoV-2 infection have been well documented across vulnerable communities during the pandemic. We assessed long COVID prevalence by vulnerability status in the post-pandemic phase.
METHODS: Symptomatic US adults testing positive for SARS-CoV-2 at CVS Health were recruited between 03/02/2023 and 05/18/2023 (CT.gov: NCT05160636). A long COVID questionnaire with 30 CDC-based symptoms was administered at week 4, month 3 and month 6 post-infection. The CDC long COVID definition was operationalized as the reporting of ≥3 new or persistent symptoms greater than 4 weeks since the acute infection. Patients were divided into quartiles of Social Vulnerability Index (SVI), with quartile 4 representing highest vulnerability. Multivariable logistic regression models were applied to predict long COVID status based on SVI, controlling for multiple covariates including age, gender, race, region, vaccination status.
RESULTS: Among 640 participants, 503 self-reported ≥1 long COVID associated symptom at week 4: 126 (25%) were in quartile 1, 193 (38%) in quartile 2, 119 (24%) in quartile 3, and 65 (13%) in quartile 4. Their mean SVI scores were, respectively, 0.16, 0.38, 0.61, and 0.83 (p<0.001). Age, race, and geographic distribution differed among groups. COVID-19 bivalent vaccination and antiviral coverage were lower (p<0.001) in vulnerable groups (quartiles 3 and 4). Respectively, at 4 weeks and 6 months since testing positive, compared with quartile 1, quartile 4 participants had higher odds of ≥3 long COVID symptoms (44.6% vs 24.6%; adjusted odds ratio (OR) 2.10, 95% confidence interval (CI) 1.03-4.26; 34.5% vs 15.5%; adjusted OR 2.32, 95% CI 1.03-5.23).
CONCLUSIONS: This study provides evidence of disparities in long COVID prevalence by vulnerability status: quartile 4 participants had twice the odds of long COVID than quartile 1. SVI can help identify communities at higher risk of long COVID and opportunities to increase vaccination and treatment coverage.
METHODS: Symptomatic US adults testing positive for SARS-CoV-2 at CVS Health were recruited between 03/02/2023 and 05/18/2023 (CT.gov: NCT05160636). A long COVID questionnaire with 30 CDC-based symptoms was administered at week 4, month 3 and month 6 post-infection. The CDC long COVID definition was operationalized as the reporting of ≥3 new or persistent symptoms greater than 4 weeks since the acute infection. Patients were divided into quartiles of Social Vulnerability Index (SVI), with quartile 4 representing highest vulnerability. Multivariable logistic regression models were applied to predict long COVID status based on SVI, controlling for multiple covariates including age, gender, race, region, vaccination status.
RESULTS: Among 640 participants, 503 self-reported ≥1 long COVID associated symptom at week 4: 126 (25%) were in quartile 1, 193 (38%) in quartile 2, 119 (24%) in quartile 3, and 65 (13%) in quartile 4. Their mean SVI scores were, respectively, 0.16, 0.38, 0.61, and 0.83 (p<0.001). Age, race, and geographic distribution differed among groups. COVID-19 bivalent vaccination and antiviral coverage were lower (p<0.001) in vulnerable groups (quartiles 3 and 4). Respectively, at 4 weeks and 6 months since testing positive, compared with quartile 1, quartile 4 participants had higher odds of ≥3 long COVID symptoms (44.6% vs 24.6%; adjusted odds ratio (OR) 2.10, 95% confidence interval (CI) 1.03-4.26; 34.5% vs 15.5%; adjusted OR 2.32, 95% CI 1.03-5.23).
CONCLUSIONS: This study provides evidence of disparities in long COVID prevalence by vulnerability status: quartile 4 participants had twice the odds of long COVID than quartile 1. SVI can help identify communities at higher risk of long COVID and opportunities to increase vaccination and treatment coverage.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
PCR185
Topic
Patient-Centered Research
Topic Subcategory
Patient-reported Outcomes & Quality of Life Outcomes
Disease
SDC: Infectious Disease (non-vaccine), SDC: Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory), STA: Vaccines