Ryu Soomin, Allgood Kristi L, Xie Yanmei, Orellana Robert C, Fleischer Nancy L
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX, USA.
Arch Public Health. 2025 Mar 10;83(1):64. doi: 10.1186/s13690-025-01553-z.
The COVID-19 pandemic has disproportionately affected socially vulnerable communities. Some individuals experience persistent symptoms and conditions of COVID-19 illness known as long COVID. As little research has examined how social vulnerability is related to long COVID, we studied this topic using Minority Health Social Vulnerability Index (MHSVI), specifically created for the COVID-19 pandemic in the U.S.
We merged county-level MHSVI data with population-based data of Michigan adults with PCR-confirmed SARS-CoV-2 infection between March 2020 and May 2022 based on respondents' county of residence. We examined the relationship between county-level MHSVI (binary: high social vulnerability ≥ 75th percentile) and two long COVID measurements, assessed a median of 18.8 months after their initial infection: (1) ongoing long COVID (yes/no) and (2) long COVID diagnosis (yes/no). We conducted modified Poisson regression models with robust standard errors to estimate prevalence ratio (PR) between associations of MHSVI and long COVID overall and by six MHSVI themes (socioeconomic status, household composition/disability, minority/language, housing type/transportation, healthcare access, medical vulnerability), adjusting for individual-level and county-level covariates.
Living in high MHSVI counties was not associated with ongoing long COVID or long COVID diagnosis. However, the associations differed by theme of MHSVI: respondents in highly socially vulnerable counties assessed by medical vulnerability had 1.32 times higher prevalence of long COVID diagnosis (95% CI:1.12 - 1.57). There were no statistically significant associations in other themes after the adjustment for covariates.
Our findings suggest the importance of upstream social determinants of health during public health emergencies and provide evidence that medically vulnerable communities need additional public health resources to cope with long COVID among their residents.
新冠疫情对社会弱势群体造成了尤为严重的影响。一些人经历了新冠疾病的持续症状和状况，即所谓的“长新冠”。由于很少有研究探讨社会脆弱性与“长新冠”之间的关系，我们使用专门为美国新冠疫情创建的少数族裔健康社会脆弱性指数（MHSVI）对这一主题进行了研究。
我们将县级MHSVI数据与2020年3月至2022年5月期间密歇根州经聚合酶链反应确诊感染严重急性呼吸综合征冠状病毒2的成年人群数据进行合并，合并依据为受访者的居住县。我们研究了县级MHSVI（二元变量：高社会脆弱性≥第75百分位数）与两项“长新冠”指标之间的关系，这两项指标在初次感染后中位数18.8个月时进行评估：（1）持续的“长新冠”（是/否）和（2）“长新冠”诊断（是/否）。我们进行了具有稳健标准误的修正泊松回归模型，以估计MHSVI与总体“长新冠”以及按MHSVI六个主题（社会经济地位、家庭构成/残疾、少数族裔/语言、住房类型/交通、医疗服务可及性、医疗脆弱性）分类的“长新冠”之间关联的患病率比（PR），并对个体层面和县级协变量进行了调整。
居住在MHSVI高的县与持续的“长新冠”或“长新冠”诊断无关。然而，关联因MHSVI主题而异：经医疗脆弱性评估，社会高度脆弱县的受访者“长新冠”诊断患病率高出1.32倍（95%置信区间：1.12 - 1.57）。在对协变量进行调整后，其他主题没有统计学上的显著关联。
我们的研究结果表明了公共卫生紧急事件期间健康的上游社会决定因素的重要性，并提供了证据，证明医疗脆弱社区需要额外的公共卫生资源来应对其居民中的“长新冠”问题。
