Long COVID Risk Higher With Discrimination, Economic Instability in Kids

Economic instability and experiences of discrimination are linked to a higher risk of long COVID in children and adolescents, according to recent research published in JAMA Pediatrics. The study highlights a concerning connection between social determinants of health and the persistence of COVID-19 symptoms beyond the initial infection.

Researchers at the University of California San Diego and collaborating institutions analyzed data from the RECOVER Pediatric Observational Cohort Study, a large-scale initiative investigating the long-term effects of COVID-19 in young people. The analysis included data from over 4,500 participants, encompassing both school-aged children (6-11 years) and adolescents (12-17 years) who had previously been infected with SARS-CoV-2.

The study examined 24 social risk factors categorized into five key domains: economic stability, social and community context, caregiver education and access to quality resources, neighborhood and built environment, and healthcare access and quality. Participants were grouped based on their level of adversity across these domains, with higher-numbered groups representing greater challenges.

The findings revealed that youth experiencing economic instability faced significantly increased odds of developing long COVID. Specifically, those in the highest adversity class for economic stability had a nearly 2.4 times higher risk compared to those with the fewest adverse factors. However, this increased risk was particularly pronounced when economic instability was coupled with food insecurity. Interestingly, economic instability alone, without concurrent food insecurity, did not demonstrate a statistically significant association with long COVID.

“This is a very interesting finding and shows how important it is to help families get the nutrition they need, especially for those with lower incomes who have other economic and social stressors,” explained Dr. Kay E. Rhee, professor of pediatrics at UC San Diego School of Medicine, in an interview with Healio. “Asking about and addressing adverse social conditions can have a significant impact on child health.”

Beyond economic factors, the study also found a strong association between adverse social and community context – specifically, experiences of discrimination and lack of social support – and an increased risk of long COVID. Youth experiencing these challenges were more than twice as likely to develop long COVID compared to those with more supportive environments.

The researchers categorized participants based on their exposure to adverse social determinants of health. Approximately one-third of the study population reported no significant adversity across the five domains, while a substantial proportion (42%) experienced challenges in two or more areas. Long COVID prevalence was lowest among those with the fewest adverse factors.

The study’s methodology involved analyzing longitudinal data collected from 52 sites across the United States, encompassing both healthcare and community settings. Caregivers completed surveys detailing their children’s experiences with social determinants of health and any ongoing symptoms suggestive of long COVID. The data collection period spanned from March 2022 to August 2024.

While the study established a clear link between social determinants of health and long COVID risk, Dr. Rhee emphasized the need for further research to disentangle the complex interplay between these factors and underlying biological predispositions. Future investigations will aim to determine the relative contribution of social factors versus pre-existing medical conditions to the development of long COVID.

The findings underscore the importance of addressing social inequities as a critical component of public health strategies aimed at mitigating the impact of long COVID in children and adolescents. Providing support for families facing economic hardship, ensuring access to nutritious food, and fostering inclusive and supportive communities may play a crucial role in reducing the burden of this emerging health challenge.

The study included 3,681 adolescents aged 12 through 17 years and 903 children aged 6 through 11 years. More than half of the participants were infected with SARS-CoV-2 prior to the emergence of the Omicron variant. Approximately 17% were suspected of having long COVID during the study period, and roughly 47% had received some level of COVID-19 vaccination.