Social Determinants of Health and Risk of Long COVID
A recent prospective observational cohort study has shed light on the associations between social determinants of health (SDoH) at the time of SARS-CoV-2 infection and the subsequent risk for long COVID. The study, published in the prestigious journal Annals of Internal Medicine, revealed that individuals with social risk factors such as economic instability and food insecurity at the time of COVID-19 infection were at a higher risk for developing long COVID.
The findings of this study underscore the pressing need for policy interventions aimed at dismantling the systemic drivers of social risk factors and addressing the glaring disparities exacerbated by the COVID-19 pandemic. The research was conducted by a team of experts from Brigham and Women’s Hospital, Harvard Medical School, and other esteemed institutions. They analyzed data from 3,787 adults enrolled in the RECOVER-Adult study between October 2021 and November 2023, all of whom had acute SARS-CoV-2 infection with the omicron variant.
Participants completed surveys on comorbidities and SDoH at baseline, followed by long COVID symptom surveys at a six-month follow-up. The researchers utilized the Healthy People 2030 categorizations for SDoH, focusing on four domains of individual-level social risk factors (economic instability, education and language access barriers, health care access and quality challenges, and lack of social or community support), as well as two area-level measures derived from ZIP code data (neighborhood poverty and household crowding).
The primary outcome assessed was the likelihood of developing long COVID based on the criteria outlined in the 2024 update of the RECOVER-Adult Long COVID Research Index (LCRI). The study revealed that individuals facing financial hardship, food insecurity, lower educational attainment, and health care access barriers were at a heightened risk of experiencing long COVID. Moreover, residing in a ZIP code characterized by higher household crowding was also linked to an increased risk of developing long COVID.
Further analyses demonstrated that a higher number of social risk factors within most domains were associated with a greater risk of long COVID. These findings underscore the enduring impact of social determinants of health on the disparities exacerbated by the COVID-19 pandemic.
For more information on this groundbreaking study, readers can refer to the article titled “Social Determinants of Health and Risk of Long COVID in the U.S. RECOVER-Adult Cohort,” published in Annals of Internal Medicine in 2025. The DOI for the article is 10.7326/ANNALS-24-01971.
This research highlights the critical role of addressing social determinants of health in mitigating the disparities associated with long COVID. By targeting and alleviating these social risk factors, policymakers and healthcare providers can work towards ensuring equitable and comprehensive care for all individuals affected by COVID-19.
