Zhengyi Fang, MS1; Rebecca Ahrnsbrak, MPS2; Andy Rekito, MS3, JAMA. Published online June 7, 2024. doi:10.1001/jama.2024.11370
New data from the Medical Expenditure Panel Survey (MEPS) Household Component support prior findings that about 7% of US adults have had post–COVID-19 condition, also known as long COVID. The household survey of the US civilian noninstitutionalized population, sponsored by the Agency for Healthcare Research and Quality, found that an estimated 6.9% of adults—17.8 million—had ever had long COVID as of early 2023.
This nationally representative survey included a sample of 17 418 adults aged 18 years or older, which corresponds to 259 million adults. A total of 8275 adults reported having had COVID-19, of which 1202 adults reported having had long COVID symptoms.
There were important differences in the MEPS survey across selected demographic and socioeconomic characteristics and by preexisting chronic conditions. Females were more likely to report having had long COVID than males in each of the 4 age groups. Overall, 8.6% of females had had long COVID compared with 5.1% of males. Both young adults and older adults had lower rates of long COVID than midlife adults. Younger people tend to be heathier in general and older adults had lower rates of COVID-19 and higher rates of booster shots in the survey.
Hispanic and White adults had higher rates of long COVID than Asian and Black adults. Both MEPS and the US Centers for Disease Control and Prevention (CDC) 2022 National Health Interview Survey (NHIS) found that Asian adults had the lowest rates of long COVID (3.3% in MEPS; 2.6% in NHIS). Asian adults also had the highest rates of booster shots in MEPS. The data showed that Black adults had the second lowest rates of long COVID; they also had the lowest rates of COVID-19. Compared with Asian and White adults, Black adults were more likely to report having lower income and educational levels and living in the South, which were all associated with lower reported rates of COVID-19. (Alaska Native, American Indian, Native Hawaiian, Pacific Islander, and multiple race adults were not included in the analysis due to small sample sizes.)
MEPS asked respondents about COVID-19 primary series vaccinations and booster shots. Adults who had received a COVID-19 booster had lower rates of long COVID than those who only had received the primary series vaccination and those who had never been vaccinated, and this finding held true for both males and females. (The difference in long COVID rates between vaccinated and unvaccinated females was not statistically significant.) These findings suggest that booster shots may enhance protection against long COVID, possibly because booster shots reduce the risk of severe COVID-19. MEPS did not find that booster shots were associated with a reduced risk of having had COVID-19 in general.
The survey categorized poverty status—based on total family income, family size, and family composition—into 4 groups: poor, low-, middle-, and high-income. Adults living in poor or low-income households usually have higher rates of chronic conditions, disabilities, and poor physical and mental health. However, MEPS did not observe significant differences in long COVID rates between adults living in poor or low-income households and those in middle- or high-income households. Adults in poor or low-income households reported lower rates of COVID-19 as well as lower levels of educational achievement, both of which were correlated with lower rates of long COVID. Adults in poor or low-income households also reported much lower rates of employment. Workers had higher rates of COVID-19 in the MEPS survey, possibly due to exposure through the workplace.
A previous study found that hypertension, chronic lung disease, obesity, diabetes, and depression were the leading risk factors for long COVID. The MEPS study confirmed that people with certain preexisting chronic conditions or obesity reported higher rates of long COVID than all adults. Adults with emphysema or chronic bronchitis reported the highest rates, which supports previous findings that chronic obstructive pulmonary disease, or COPD, is a major risk factor for serious COVID-19 and, in turn, long COVID. To find the respondents’ condition status before the pandemic, the MEPS analysis used age at diagnosis or linked back to chronic bronchitis information from 2019.
Long COVID was first reported anecdotally in April 2020 and has continued to cause significant health problems and disability in the wake of the COVID-19 pandemic. Several datasets have now quantified long COVID’s prevalence in the US.
The 2022 NHIS estimated that 6.9% of adults in the US have had long COVID, with differences observed by sex, age group, race and ethnicity, poverty status, and urbanicity. Similarly, 6.4% of adults in the US have had long COVID, with variation by state, based on the CDC’s 2022 Behavioral Risk Factor Surveillance System.
MEPS defined long COVID as symptoms lasting 3 months or longer after the initial SARS-CoV-2 infection that were not previously present. It found that females, people aged 35 to 64 years, Hispanic and White people, individuals with chronic conditions, and those who did not receive the COVID-19 booster were more likely to report long COVID.
These findings support the CDC’s definition that long COVID “represents many potentially overlapping entities, likely with different biological causes and different sets of risk factors and outcomes.”