Department of Health Services Policy and Management, University of South Carolina Arnold School of Public Health, Columbia.
Department of Economics, Montana State University, Bozeman.
JAMA Netw Open. 2023 Dec 1;6(12):e2347318. doi: 10.1001/jamanetworkopen.2023.47318.
Little is known about the association of severe COVID-19 and post-COVID-19 conditions with household finances.
To examine associations between COVID-19 outcomes, pandemic-related economic hardship, and prepandemic socioeconomic status among families in the US.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the Panel Study of Income Dynamics (PSID), a nationally representative, longitudinal study. Data included 6932 families active in the PSID in both 2019 and 2021.
Ordinal exposure categories were defined based on whether the reference person or spouse or partner reported a positive COVID-19 diagnosis and (1) persistent COVID-19 symptoms, (2) previous severe COVID-19, or (3) previous moderate, mild, or asymptomatic COVID-19. Families with no history of COVID-19 served as the reference group.
Outcomes included whether a resident family member was laid off or furloughed, lost earnings, or had any financial difficulties due to the COVID-19 pandemic.
In this cohort study of 6932 families (772 Hispanic families [weighted, 13.5%; 95% CI, 12.4%-14.6%], 2725 non-Hispanic Black families [weighted, 13.1%; 95% CI, 12.3%-14.1%], and 3242 non-Hispanic White families [weighted, 66.8%; 95% CI, 65.2%-68.3%]), close to 1 in 4 (2222 [weighted, 27.0%; 95% CI, 25.6%-28.6%]) reported income below 200% of the US Census Bureau poverty threshold. In survey-weighted regression models adjusted for prepandemic sociodemographic characteristics and experiences of economic hardship, the odds of reporting pandemic-related economic hardship were 2.0 to 3.7 times higher among families headed by an adult with persistent COVID-19 symptoms (laid off or furloughed: adjusted odds ratio [AOR], 1.98 [95% CI, 1.37-2.85]; lost earnings: AOR, 2.86 [95% CI, 2.06-3.97]; financial difficulties: AOR, 3.72 [95% CI, 2.62-5.27]) and 1.7 to 2.0 times higher among families headed by an adult with previous severe COVID-19 (laid off or furloughed: AOR, 1.69 [95% CI, 1.13-2.53]; lost earnings: AOR, 1.99 [95% CI, 1.37-2.90]; financial difficulties: AOR, 1.87 [95% CI, 1.25-2.80]) compared with families with no history of COVID-19. Families headed by an adult with persistent COVID-19 symptoms had increased odds of reporting financial difficulties due to the pandemic regardless of prepandemic socioeconomic status (families with lower income: AOR, 3.71 [95% CI, 1.94-7.10]; families with higher income: AOR, 3.74 [95% CI, 2.48-5.63]). Previous severe COVID-19 was significantly associated with financial difficulties among families with lower income (AOR, 2.59 [95% CI, 1.26-5.31]) but was not significantly associated with financial difficulties among those with high income (OR, 1.56 [95% CI, 0.95-2.56]).
This cohort study suggests that persistent COVID-19 symptoms and, to a lesser extent, previous severe COVID-19 were associated with increased odds of pandemic-related economic hardship in a cohort of US families. The economic consequences of COVID-19 varied according to socioeconomic status; families with lower income before the pandemic were more vulnerable to employment disruptions and earnings losses associated with an adult family member's COVID-19 illness.
重要性：关于严重 COVID-19 和 COVID-19 后状况与家庭财务之间的关联，人们知之甚少。
目的：在美国的家庭中，研究 COVID-19 结局、与大流行相关的经济困难以及大流行前社会经济地位之间的关联。
设计、地点和参与者：这项队列研究使用了来自收入动态面板研究（PSID）的数据，这是一项具有全国代表性的纵向研究。数据包括在 2019 年和 2021 年均活跃在 PSID 中的 6932 个家庭。
暴露：基于参考人或配偶或伴侣是否报告 COVID-19 阳性诊断以及（1）持续的 COVID-19 症状、（2）先前的严重 COVID-19 或（3）先前的中度、轻度或无症状 COVID-19，定义了有序暴露类别。没有 COVID-19 病史的家庭作为参考组。
主要结果和措施：结果包括是否有居民家庭成员被解雇或停职、失业或因 COVID-19 大流行而面临任何财务困难。
结果：在这项涉及 6932 个家庭（772 个西班牙裔家庭[加权，13.5%；95%CI，12.4%-14.6%]、2725 个非西班牙裔黑人家庭[加权，13.1%；95%CI，12.3%-14.1%]和 3242 个非西班牙裔白人家庭[加权，66.8%；95%CI，65.2%-68.3%]）的队列研究中，近 1/4（2222 个[加权，27.0%；95%CI，25.6%-28.6%]）报告收入低于美国人口普查局贫困线的 200%。在调整了大流行前社会人口统计学特征和经济困难经历的调查加权回归模型中，持续 COVID-19 症状成人领导的家庭报告与大流行相关的经济困难的可能性是没有 COVID-19 病史的家庭的 2.0 到 3.7 倍（解雇或停职：调整后的优势比[OR]，1.98[95%CI，1.37-2.85]；失业：OR，2.86[95%CI，2.06-3.97]；经济困难：OR，3.72[95%CI，2.62-5.27]），先前有严重 COVID-19 的成人领导的家庭报告与大流行相关的经济困难的可能性是没有 COVID-19 病史的家庭的 1.7 到 2.0 倍（解雇或停职：OR，1.69[95%CI，1.13-2.53]；失业：OR，1.99[95%CI，1.37-2.90]；经济困难：OR，1.87[95%CI，1.25-2.80]）。与没有 COVID-19 病史的家庭相比，持续 COVID-19 症状的家庭报告因大流行而出现经济困难的可能性增加，无论大流行前的社会经济地位如何（收入较低的家庭：OR，3.71[95%CI，1.94-7.10]；收入较高的家庭：OR，3.74[95%CI，2.48-5.63]）。先前有严重 COVID-19 与收入较低的家庭经济困难显著相关（OR，2.59[95%CI，1.26-5.31]），但与收入较高的家庭经济困难没有显著相关（OR，1.56[95%CI，0.95-2.56]）。
结论和相关性：这项队列研究表明，持续的 COVID-19 症状，以及在较小程度上，先前的严重 COVID-19 与美国家庭 COVID-19 相关的经济困难的可能性增加有关。COVID-19 的经济后果因社会经济地位而异；大流行前收入较低的家庭更容易因家庭成员的 COVID-19 疾病而出现就业中断和收入损失。
