Economic instability linked to higher risk of long COVID in children

New research led by Mass General Brigham investigators suggests that long COVID is more prevalent in school-aged children and adolescents who experience economic instability and adverse social conditions. The multi-center, observational study found that the risk of long COVID was significantly higher in households that faced food insecurity and challenges such as low social support and high levels of discrimination. Results are published in JAMA Pediatrics.

Long COVID in children is especially concerning because of the potential for long-term health effects that could persist into adulthood. Public health interventions that target social risk factors-such as food insecurity and lack of social support-are critical to reduce the burden of long COVID and safeguard the overall health of children as they continue to acquire COVID-19."

Tanayott Thaweethai, PhD, co-first author, Massachusetts General Hospital Biostatistics

Social determinants of health (SDOH) are non-medical factors that stem from the environment in which a person lives and interacts with others. Prior research has either been conducted in adults or focused largely on how adverse SDOH can impact the risk of getting sick with COVID-19. However, experts estimate that millions of children around the world experience prolonged COVID symptoms, highlighting the need to examine the link between adverse SDOH and pediatric long COVID.

Seeking answers, the research team analyzed data from a subset of the federally funded RECOVER (Researching COVID to Enhance Recovery) Initiative. The cohort included 903 school-aged children and 3,681 adolescents with history of SARS-CoV-2 infection, who were recruited at 52 sites across the U.S. The study examined associations between long COVID and 24 social risk factors, grouped into five main domains: economic stability (e.g., food insecurity, poverty), social and community context (e.g., caregiver marital status, discrimination), caregiver education access and quality, neighborhood and built environment, and healthcare access and quality.

The researchers found that economic instability and poor social context, like difficulty covering expenses or facing discrimination, mattered most and had the greatest impact on risk of long COVID. By contrast, food security was protective, even for families with other economic challenges.

The authors speculate that healthy diets may decrease inflammation and thus protect against risk of long COVID. Further research is needed to investigate whether addressing these adverse social factors can mitigate future disease risk.