JMIR Publications

ABSTRACT

Background:

Long COVID is a clinical condition that significantly influences quality of life, productivity, and morbidity in the individuals affected. Much of the research to date has examined medical comorbidities as risk factors for long COVID, but there remains a substantial need to understand social and behavioral risk factors for long COVID as well.

Objective:

The objective of this study was to investigate the prevalence and predictors of long COVID among adults in the United States (US) through the application of the Andersen Behavioral Model (ABM).

Methods:

This cross-sectional database study utilized the 2022 Medical Expenditure Panel Survey (MEPS) dataset. Variables that served as predictors in this analysis were organized according to the ABM. The appropriate weighting variable was employed to obtain weighted population-based estimates. Between group differences (i.e., those with long COVID versus those without) were compared using chi-squared tests, and a multivariable binomial logistic regression model was developed to assess the association between each variable and having a diagnosis of long COVID.

Results:

A total of 11,266 individuals were eligible for inclusion in the study. This represented a weighted population of 256,500,584 US adults. Of these, 790 (weighted population = 18,397,214) had a diagnosis of long COVID, while 10,476 (weighted population = 238,103,371) did not. Variables identified that were statistically associated with having long COVID among US adults included: three predisposing variables (age, sex, Asian race), two enabling variables (marital status and employment status), three need variables (number of chronic conditions, health status, and instrumental activities of daily living limitations), one personal health practices variable (ever had Covid-19 vaccine), and one external environmental variable (South vs. West region).

Conclusions:

In this study, factors that reduced the risk of long COVID symptoms included age (65 and older), male sex, Asian race, fewer chronic health conditions, excellent or very good health status, receiving the COVID-19 vaccine, and living in the South versus the Western United States. Conversely, factors such as being married, being employed, and having limitations in instrumental activities of daily living increased the risk of long COVID. These findings add to existing literature on the complex environmental and social factors that influence development of long COVID.