Social Determinants of Health and Risk for Long COVID in the: U.S. RECOVER-Adult Cohort

Candace H. Feldman; Leah Santacroce; Ingrid V. Bassett; Tanayott Thaweethai; Radica Alicic; Rachel Atchley-Challenner; Alicia Chung; Mark P. Goldberg; Carol R. Horowitz; Karen B. Jacobson; J. Daniel Kelly; Stacey Knight; Karen Lutrick; Praveen Mudumbi; Sairam Parthasarathy; Heather Prendergast; Yuri Quintana; Nasser Sharareh; Judd Shellito; Zaki A. Sherif; Brittany D. Taylor; Emily Taylor; Joel Tsevat; Zanthia Wiley; Natasha J. Williams; Lynn Yee; Lisa Aponte-Soto; Jhony Baissary; Jasmine Berry; Alexander W. Charney; Maged M. Costantine; Alexandria M. Duven; Nathaniel Erdmann; Kacey C. Ernst; Elen M. Feuerriegel; Valerie J. Flaherman; Minjoung Go; Kellie Hawkins; Vanessa Jacoby; Janice John; Sara Kelly; Elijah Kindred; Adeyinka Laiyemo; Emily B. Levitan; Bruce D. Levy; Jennifer K. Logue; Jai G. Marathe; Jeffrey N. Martin; Grace A. McComsey; Torri D. Metz; Tony Minor; Aoyjai P. Montgomery; Janet M. Mullington; Igho Ofotokun; Megumi J. Okumura; Michael J. Peluso; Kristen Pogreba-Brown; Hengameh Raissy; Johana M. Rosas; Upinder Singh; Timothy VanWagoner; Cheryl R. Clark; Elizabeth W. Karlson

doi:10.7326/ANNALS-24-01971

Social Determinants of Health and Risk for Long COVID in the: U.S. RECOVER-Adult Cohort

Candace H. Feldman
, Leah Santacroce
, Ingrid V. Bassett
, Tanayott Thaweethai
, Radica Alicic
, Rachel Atchley-Challenner
, Alicia Chung
, Mark P. Goldberg
, Carol R. Horowitz
, Karen B. Jacobson
, J. Daniel Kelly
, Stacey Knight
, Karen Lutrick
, Praveen Mudumbi
, Sairam Parthasarathy
, Heather Prendergast
, Yuri Quintana
, Nasser Sharareh
, Judd Shellito
, Zaki A. Sherif

Brittany D. Taylor, Emily Taylor, Joel Tsevat, Zanthia Wiley, Natasha J. Williams, Lynn Yee, Lisa Aponte-Soto, Jhony Baissary, Jasmine Berry, Alexander W. Charney, Maged M. Costantine, Alexandria M. Duven, Nathaniel Erdmann, Kacey C. Ernst, Elen M. Feuerriegel, Valerie J. Flaherman, Minjoung Go, Kellie Hawkins, Vanessa Jacoby, Janice John, Sara Kelly, Elijah Kindred, Adeyinka Laiyemo, Emily B. Levitan, Bruce D. Levy, Jennifer K. Logue, Jai G. Marathe, Jeffrey N. Martin, Grace A. McComsey, Torri D. Metz, Tony Minor, Aoyjai P. Montgomery, Janet M. Mullington, Igho Ofotokun, Megumi J. Okumura, Michael J. Peluso, Kristen Pogreba-Brown, Hengameh Raissy, Johana M. Rosas, Upinder Singh, Timothy VanWagoner, Cheryl R. Clark, Elizabeth W. Karlson

Family and Community Medicine

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Background: Social determinants of health (SDoH) contribute to disparities in SARS-CoV-2 infection, but their associations with long COVID are unknown. Objective: To determine associations between SDoH at the time of SARS-CoV-2 infection and risk for long COVID. Design: Prospective observational cohort study. Setting: 33 states plus Washington, DC, and Puerto Rico. Participants: Adults (aged =18 years) enrolled in RECOVER-Adult (Researching COVID to Enhance Recovery) between October 2021 and November 2023 who were within 30 days of SARS-CoV-2 infection; completed baseline SDoH, comorbidity, and pregnancy questionnaires; and were followed prospectively. Measurements: Social risk factors from SDoH baseline questionnaires, ZIP code poverty and household crowding measures, and a weighted score of 11 or higher on the Long COVID Research Index 6 months after infection. Results: Among 3787 participants, 418 (11%) developed long COVID. After adjustment for demographic characteristics, pregnancy, disability, comorbidities, SARS-CoV-2 severity, and vaccinations, financial hardship (adjusted marginal risk ratio [ARR], 2.36 [95% CI, 1.97 to 2.91]), food insecurity (ARR, 2.36 [CI, 1.83 to 2.98]), less than a college education (ARR, 1.60 [CI, 1.30 to 1.97]), experiences of medical discrimination (ARR, 2.37 [CI, 1.94 to 2.83]), skipped medical care due to cost (ARR, 2.87 [CI, 2.22 to 3.70]), and lack of social support (ARR, 1.79 [CI, 1.50 to 2.17]) were associated with increased risk for long COVID. Living in ZIP codes with the highest (vs. lowest) household crowding was also associated with greater risk (ARR, 1.36 [CI, 1.05 to 1.71]). Limitation: Selection bias may influence observed associations and generalizability. Conclusion: Participants with social risk factors at the time of SARS-CoV-2 infection had greater risk for subsequent long COVID than those without. Future studies should determine whether social risk factor interventions mitigate long-term effects of SARS-CoV-2 infection.

Original language	English (US)
Pages (from-to)	1287-1297
Number of pages	11
Journal	Annals of internal medicine
Volume	178
Issue number	9
DOIs	https://doi.org/10.7326/ANNALS-24-01971
State	Published - Sep 2025

ASJC Scopus subject areas

Internal Medicine

Access to Document

10.7326/ANNALS-24-01971

Cite this

Feldman, C. H., Santacroce, L., Bassett, I. V., Thaweethai, T., Alicic, R., Atchley-Challenner, R., Chung, A., Goldberg, M. P., Horowitz, C. R., Jacobson, K. B., Daniel Kelly, J., Knight, S., Lutrick, K., Mudumbi, P., Parthasarathy, S., Prendergast, H., Quintana, Y., Sharareh, N., Shellito, J., ... Karlson, E. W. (2025). Social Determinants of Health and Risk for Long COVID in the: U.S. RECOVER-Adult Cohort. Annals of internal medicine, 178(9), 1287-1297. https://doi.org/10.7326/ANNALS-24-01971

Feldman, CH, Santacroce, L, Bassett, IV, Thaweethai, T, Alicic, R, Atchley-Challenner, R, Chung, A, Goldberg, MP, Horowitz, CR, Jacobson, KB, Daniel Kelly, J, Knight, S, Lutrick, K, Mudumbi, P, Parthasarathy, S, Prendergast, H, Quintana, Y, Sharareh, N, Shellito, J, Sherif, ZA, Taylor, BD, Taylor, E, Tsevat, J, Wiley, Z, Williams, NJ, Yee, L, Aponte-Soto, L, Baissary, J, Berry, J, Charney, AW, Costantine, MM, Duven, AM, Erdmann, N, Ernst, KC, Feuerriegel, EM, Flaherman, VJ, Go, M, Hawkins, K, Jacoby, V, John, J, Kelly, S, Kindred, E, Laiyemo, A, Levitan, EB, Levy, BD, Logue, JK, Marathe, JG, Martin, JN, McComsey, GA, Metz, TD, Minor, T, Montgomery, AP, Mullington, JM, Ofotokun, I, Okumura, MJ, Peluso, MJ, Pogreba-Brown, K, Raissy, H, Rosas, JM, Singh, U, VanWagoner, T, Clark, CR & Karlson, EW 2025, 'Social Determinants of Health and Risk for Long COVID in the: U.S. RECOVER-Adult Cohort', Annals of internal medicine, vol. 178, no. 9, pp. 1287-1297. https://doi.org/10.7326/ANNALS-24-01971

@article{1531c72101484b99900efc552b3ada8e,

title = "Social Determinants of Health and Risk for Long COVID in the: U.S. RECOVER-Adult Cohort",

abstract = "Background: Social determinants of health (SDoH) contribute to disparities in SARS-CoV-2 infection, but their associations with long COVID are unknown. Objective: To determine associations between SDoH at the time of SARS-CoV-2 infection and risk for long COVID. Design: Prospective observational cohort study. Setting: 33 states plus Washington, DC, and Puerto Rico. Participants: Adults (aged =18 years) enrolled in RECOVER-Adult (Researching COVID to Enhance Recovery) between October 2021 and November 2023 who were within 30 days of SARS-CoV-2 infection; completed baseline SDoH, comorbidity, and pregnancy questionnaires; and were followed prospectively. Measurements: Social risk factors from SDoH baseline questionnaires, ZIP code poverty and household crowding measures, and a weighted score of 11 or higher on the Long COVID Research Index 6 months after infection. Results: Among 3787 participants, 418 (11\%) developed long COVID. After adjustment for demographic characteristics, pregnancy, disability, comorbidities, SARS-CoV-2 severity, and vaccinations, financial hardship (adjusted marginal risk ratio [ARR], 2.36 [95\% CI, 1.97 to 2.91]), food insecurity (ARR, 2.36 [CI, 1.83 to 2.98]), less than a college education (ARR, 1.60 [CI, 1.30 to 1.97]), experiences of medical discrimination (ARR, 2.37 [CI, 1.94 to 2.83]), skipped medical care due to cost (ARR, 2.87 [CI, 2.22 to 3.70]), and lack of social support (ARR, 1.79 [CI, 1.50 to 2.17]) were associated with increased risk for long COVID. Living in ZIP codes with the highest (vs. lowest) household crowding was also associated with greater risk (ARR, 1.36 [CI, 1.05 to 1.71]). Limitation: Selection bias may influence observed associations and generalizability. Conclusion: Participants with social risk factors at the time of SARS-CoV-2 infection had greater risk for subsequent long COVID than those without. Future studies should determine whether social risk factor interventions mitigate long-term effects of SARS-CoV-2 infection.",

author = "Feldman, \{Candace H.\} and Leah Santacroce and Bassett, \{Ingrid V.\} and Tanayott Thaweethai and Radica Alicic and Rachel Atchley-Challenner and Alicia Chung and Goldberg, \{Mark P.\} and Horowitz, \{Carol R.\} and Jacobson, \{Karen B.\} and \{Daniel Kelly\}, J. and Stacey Knight and Karen Lutrick and Praveen Mudumbi and Sairam Parthasarathy and Heather Prendergast and Yuri Quintana and Nasser Sharareh and Judd Shellito and Sherif, \{Zaki A.\} and Taylor, \{Brittany D.\} and Emily Taylor and Joel Tsevat and Zanthia Wiley and Williams, \{Natasha J.\} and Lynn Yee and Lisa Aponte-Soto and Jhony Baissary and Jasmine Berry and Charney, \{Alexander W.\} and Costantine, \{Maged M.\} and Duven, \{Alexandria M.\} and Nathaniel Erdmann and Ernst, \{Kacey C.\} and Feuerriegel, \{Elen M.\} and Flaherman, \{Valerie J.\} and Minjoung Go and Kellie Hawkins and Vanessa Jacoby and Janice John and Sara Kelly and Elijah Kindred and Adeyinka Laiyemo and Levitan, \{Emily B.\} and Levy, \{Bruce D.\} and Logue, \{Jennifer K.\} and Marathe, \{Jai G.\} and Martin, \{Jeffrey N.\} and McComsey, \{Grace A.\} and Metz, \{Torri D.\} and Tony Minor and Montgomery, \{Aoyjai P.\} and Mullington, \{Janet M.\} and Igho Ofotokun and Okumura, \{Megumi J.\} and Peluso, \{Michael J.\} and Kristen Pogreba-Brown and Hengameh Raissy and Rosas, \{Johana M.\} and Upinder Singh and Timothy VanWagoner and Clark, \{Cheryl R.\} and Karlson, \{Elizabeth W.\}",

note = "Publisher Copyright: {\textcopyright} 2025 American College of Physicians.",

year = "2025",

month = sep,

doi = "10.7326/ANNALS-24-01971",

language = "English (US)",

volume = "178",

pages = "1287--1297",

journal = "Annals of internal medicine",

issn = "0003-4819",

publisher = "American College of Physicians",

number = "9",

}

TY - JOUR

T1 - Social Determinants of Health and Risk for Long COVID in the

T2 - U.S. RECOVER-Adult Cohort

AU - Feldman, Candace H.

AU - Santacroce, Leah

AU - Bassett, Ingrid V.

AU - Thaweethai, Tanayott

AU - Alicic, Radica

AU - Atchley-Challenner, Rachel

AU - Chung, Alicia

AU - Goldberg, Mark P.

AU - Horowitz, Carol R.

AU - Jacobson, Karen B.

AU - Daniel Kelly, J.

AU - Knight, Stacey

AU - Lutrick, Karen

AU - Mudumbi, Praveen

AU - Parthasarathy, Sairam

AU - Prendergast, Heather

AU - Quintana, Yuri

AU - Sharareh, Nasser

AU - Shellito, Judd

AU - Sherif, Zaki A.

AU - Taylor, Brittany D.

AU - Taylor, Emily

AU - Tsevat, Joel

AU - Wiley, Zanthia

AU - Williams, Natasha J.

AU - Yee, Lynn

AU - Aponte-Soto, Lisa

AU - Baissary, Jhony

AU - Berry, Jasmine

AU - Charney, Alexander W.

AU - Costantine, Maged M.

AU - Duven, Alexandria M.

AU - Erdmann, Nathaniel

AU - Ernst, Kacey C.

AU - Feuerriegel, Elen M.

AU - Flaherman, Valerie J.

AU - Go, Minjoung

AU - Hawkins, Kellie

AU - Jacoby, Vanessa

AU - John, Janice

AU - Kelly, Sara

AU - Kindred, Elijah

AU - Laiyemo, Adeyinka

AU - Levitan, Emily B.

AU - Levy, Bruce D.

AU - Logue, Jennifer K.

AU - Marathe, Jai G.

AU - Martin, Jeffrey N.

AU - McComsey, Grace A.

AU - Metz, Torri D.

AU - Minor, Tony

AU - Montgomery, Aoyjai P.

AU - Mullington, Janet M.

AU - Ofotokun, Igho

AU - Okumura, Megumi J.

AU - Peluso, Michael J.

AU - Pogreba-Brown, Kristen

AU - Raissy, Hengameh

AU - Rosas, Johana M.

AU - Singh, Upinder

AU - VanWagoner, Timothy

AU - Clark, Cheryl R.

AU - Karlson, Elizabeth W.

PY - 2025/9

Y1 - 2025/9

N2 - Background: Social determinants of health (SDoH) contribute to disparities in SARS-CoV-2 infection, but their associations with long COVID are unknown. Objective: To determine associations between SDoH at the time of SARS-CoV-2 infection and risk for long COVID. Design: Prospective observational cohort study. Setting: 33 states plus Washington, DC, and Puerto Rico. Participants: Adults (aged =18 years) enrolled in RECOVER-Adult (Researching COVID to Enhance Recovery) between October 2021 and November 2023 who were within 30 days of SARS-CoV-2 infection; completed baseline SDoH, comorbidity, and pregnancy questionnaires; and were followed prospectively. Measurements: Social risk factors from SDoH baseline questionnaires, ZIP code poverty and household crowding measures, and a weighted score of 11 or higher on the Long COVID Research Index 6 months after infection. Results: Among 3787 participants, 418 (11%) developed long COVID. After adjustment for demographic characteristics, pregnancy, disability, comorbidities, SARS-CoV-2 severity, and vaccinations, financial hardship (adjusted marginal risk ratio [ARR], 2.36 [95% CI, 1.97 to 2.91]), food insecurity (ARR, 2.36 [CI, 1.83 to 2.98]), less than a college education (ARR, 1.60 [CI, 1.30 to 1.97]), experiences of medical discrimination (ARR, 2.37 [CI, 1.94 to 2.83]), skipped medical care due to cost (ARR, 2.87 [CI, 2.22 to 3.70]), and lack of social support (ARR, 1.79 [CI, 1.50 to 2.17]) were associated with increased risk for long COVID. Living in ZIP codes with the highest (vs. lowest) household crowding was also associated with greater risk (ARR, 1.36 [CI, 1.05 to 1.71]). Limitation: Selection bias may influence observed associations and generalizability. Conclusion: Participants with social risk factors at the time of SARS-CoV-2 infection had greater risk for subsequent long COVID than those without. Future studies should determine whether social risk factor interventions mitigate long-term effects of SARS-CoV-2 infection.

AB - Background: Social determinants of health (SDoH) contribute to disparities in SARS-CoV-2 infection, but their associations with long COVID are unknown. Objective: To determine associations between SDoH at the time of SARS-CoV-2 infection and risk for long COVID. Design: Prospective observational cohort study. Setting: 33 states plus Washington, DC, and Puerto Rico. Participants: Adults (aged =18 years) enrolled in RECOVER-Adult (Researching COVID to Enhance Recovery) between October 2021 and November 2023 who were within 30 days of SARS-CoV-2 infection; completed baseline SDoH, comorbidity, and pregnancy questionnaires; and were followed prospectively. Measurements: Social risk factors from SDoH baseline questionnaires, ZIP code poverty and household crowding measures, and a weighted score of 11 or higher on the Long COVID Research Index 6 months after infection. Results: Among 3787 participants, 418 (11%) developed long COVID. After adjustment for demographic characteristics, pregnancy, disability, comorbidities, SARS-CoV-2 severity, and vaccinations, financial hardship (adjusted marginal risk ratio [ARR], 2.36 [95% CI, 1.97 to 2.91]), food insecurity (ARR, 2.36 [CI, 1.83 to 2.98]), less than a college education (ARR, 1.60 [CI, 1.30 to 1.97]), experiences of medical discrimination (ARR, 2.37 [CI, 1.94 to 2.83]), skipped medical care due to cost (ARR, 2.87 [CI, 2.22 to 3.70]), and lack of social support (ARR, 1.79 [CI, 1.50 to 2.17]) were associated with increased risk for long COVID. Living in ZIP codes with the highest (vs. lowest) household crowding was also associated with greater risk (ARR, 1.36 [CI, 1.05 to 1.71]). Limitation: Selection bias may influence observed associations and generalizability. Conclusion: Participants with social risk factors at the time of SARS-CoV-2 infection had greater risk for subsequent long COVID than those without. Future studies should determine whether social risk factor interventions mitigate long-term effects of SARS-CoV-2 infection.

UR - https://www.scopus.com/pages/publications/105016417648

UR - https://www.scopus.com/pages/publications/105016417648#tab=citedBy

U2 - 10.7326/ANNALS-24-01971

DO - 10.7326/ANNALS-24-01971

M3 - Article

C2 - 40720834

AN - SCOPUS:105016417648

SN - 0003-4819

VL - 178

SP - 1287

EP - 1297

JO - Annals of internal medicine

JF - Annals of internal medicine

IS - 9

ER -

Social Determinants of Health and Risk for Long COVID in the: U.S. RECOVER-Adult Cohort

Abstract

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this