Study shows lasting COVID-19 symptoms lead to economic struggles for US families

In a recent study published in the journal JAMA Network Open, researchers investigated whether coronavirus disease 2019 (COVID-19) severity and symptom persistence impacted the economic conditions of United States (US) families.

Millions of US adults have experienced COVID-19-related hospitalizations and activity-limiting post-COVID-19 conditions (PCCs). Severe COVID-19 and PCCs can have significant economic consequences, with symptoms affecting daily functioning, job loss, and household finances being further stressed. Low-income families may experience more severe COVID-19 implications due to fewer resources to buffer against financial shocks. However, data on the associations between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and PCCs with family finances are limited.

Study: Association of Severe COVID-19 and Persistent COVID-19 Symptoms With Economic Hardship Among US Families. Image Credit: eldar nurkovic / ShutterstockStudy: Association of Severe COVID-19 and Persistent COVID-19 Symptoms With Economic Hardship Among US Families. Image Credit: eldar nurkovic / Shutterstock

About the study

In the present cohort study, researchers examined associations between SARS-CoV-2-related financial difficulties and pre-COVID-19 socioeconomic conditions among US families.

The researchers analyzed the Panel Study of Income Dynamics (PSID) 2019 and 2021 national-level study data, including 6,932 active families. The PSID-2021 survey was conducted between 19 March and 31 December 2021, and the PSID-2021 Early Release file included data from 8,468 families in PSID research in 2019 and two years later. The team merged post-pandemic measures of family economic hardship and COVID-19-associated health outcomes with pre-COVID-19 sociodemographic characteristics.

The researchers defined exposure categories according to the reference individual's, partner's, or spouse's SARS-CoV-2 infection status, symptom duration, and prior history of mild-moderate or severe SARS-CoV-2 infection. Outcomes included COVID-19-related furloughed or laid-off family members, lost earnings, and financial difficulties.

The team examined three indicators of family-level financial difficulties reported by the reference individual in the PSID-2021 survey: a family member furloughed or laid off due to COVID-19, a family member lost earnings due to COVID-19, and a family member had financial struggles due to COVID-19. They obtained COVID-19 severity and symptom duration data for the reference individual, spouse, or partner.

The researchers identified closely related indicators of economic hardship collected in the PSID-2019, such as whether the reference individual, spouse, or partner missed work since they were temporarily laid off, total family labor income or any family member had a credit card or store card debt. Multinomial logistic regression modeling was performed for analysis, and adjusted odds ratios (AORs) were calculated. The PSID-2019 team analyzed sociodemographic characteristics such as the presence of children under 16, the reference individual's age, self-reported race and ethnicity, education attainment, total family income, poverty thresholds, health insurance absences in the past two years, geographic region, and nonmetropolitan residence in a nonmetropolitan area. They excluded families with missing sociodemographic or economic data and indeterminate SARS-CoV-2 exposure.

Results

Among 6,932 families, the likelihood of facing economic hardship was higher for households managed by adults with persistent SARS-CoV-2 infection symptoms and, although to a lower extent, those headed by adults with prior severe SARS-CoV-2 infection history than those without prior COVID-19 history. Households with lower incomes in pre-pandemic times were more susceptible to job disruptions and loss of earnings related to adult household member's SARS-CoV-2 infection status. Among 6,932 families, 772 (14%) included Hispanic individuals, 2,725 (13%) included black individuals of non-Hispanic ethnicity, and 3,242 (67%) included white individuals of non-Hispanic ethnicity.

Nearly one in four [2,222 (27%)] reported household income lower than 200.0% of the United States Census Bureau cut-off for poverty. Regression modeling adjusting for pre-COVID-19 sociodemographic variables and economic hardship experiences, the likelihood of reporting COVID-19-related financial hardship was two- to four-fold higher among households managed by adult individuals with persistent SARS-CoV-2 infection symptoms [furloughed or laid-off: AOR, 2.0; lost income: AOR, 2.9; economic hardship: AOR, 3.7) and two-fold higher among those managed by adults with prior history of severe SARS-CoV-2 infection (furloughed or laid-off: AOR, 1.7; lost income: AOR, 2.0; economic hardship: AOR, 1.9) compared to those without prior COVID-19 history.

Families managed by adults with persistent SARS-CoV-2 infection symptoms were likely to report economic struggles due to COVID-19 irrespective of pre-COVID-19 socioeconomic conditions (lower-income households: AOR, 3.7; higher-income households: AOR, 3.7). Severe SARS-CoV-2 infection history was significantly related to economic hardships among lower-income households (AOR, 2.6); however, no significant associations were observed with financial struggles in higher-income families (OR, 1.6).

Overall, the study findings showed that persistent symptoms of SARS-CoV-2 infection and, although to a lower extent, prior severe SARS-CoV-2 infection history were related to an increased likelihood of COVID-19-associated financial difficulties among United States families. The financial implications of SARS-CoV-2 infection varied by socioeconomic level; households with lower household income in pre-pandemic times were more susceptible to job disruptions and income losses related to SARS-CoV-2 infections among adult family members. The findings indicate that policy actions to mitigate PCC-related household financial hardship merit continued discussion.

Journal reference:
Pooja Toshniwal Paharia

Written by

Pooja Toshniwal Paharia

Pooja Toshniwal Paharia is an oral and maxillofacial physician and radiologist based in Pune, India. Her academic background is in Oral Medicine and Radiology. She has extensive experience in research and evidence-based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.

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