Xiang Junwei, Zheng Hu, Cai Yuhang, Chen Siyuan, Wang Yuanyin, Chen Ran
College & Hospital of Stomatology, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei, 230032, China.
Anhui Med Univ, Affiliated Hosp 1, Hefei, 230032, China.
BMC Med. 2025 Apr 7;23(1):207. doi: 10.1186/s12916-025-04039-5.
The COVID-19 pandemic has exacerbated health disparities, with long COVID emerging as a major global public health challenge. Although clinical risk factors for long COVID are well-documented, the cumulative burden of adverse social determinants of health (SDoH) remains underexplored. This study aims to investigate the association between cumulative social disadvantage and long COVID.
Using data from the 2022 and 2023 National Health Interview Survey cycles (n = 16,446 U.S.adults), cumulative social disadvantage was quantified through 18 SDoH indicators and categorized into quartiles. The highest quartile represents the most disadvantaged individuals. Long COVID was defined as self-reported symptoms persisting for three months or longer. Weighted logistic regression models were used to examine the association, adjusting for demographic and clinical variables.
Adults in the highest quartile of cumulative social disadvantage exhibited an increased odds of experiencing long COVID compared to those in the lowest quartile (AOR = 2.52, 95% Cl: 2.13, 2.98). This association persisted across demographic subgroups, with particularly pronounced effects among women and non-Hispanic Blacks. Hispanics and non-Hispanic Whites showed weaker, but still statistically significant. Key contributors included mental health difficulties, economic instability, and healthcare access barriers. Furthermore, cumulative social disadvantage was linked to fair or poor general health status among individuals with long COVID.
This study highlights the positive association between cumulative social disadvantage and long COVID. Addressing systemic inequities through integrated public health strategies is essential to mitigate the burden of long COVID and reduce social disparities in health.
新冠疫情加剧了健康差距，长期新冠已成为一项重大的全球公共卫生挑战。尽管长期新冠的临床风险因素已有充分记录，但健康的不良社会决定因素（SDoH）的累积负担仍未得到充分探索。本研究旨在调查累积社会劣势与长期新冠之间的关联。
利用2022年和2023年国家健康访谈调查周期的数据（n = 16446名美国成年人），通过18个SDoH指标对累积社会劣势进行量化，并分为四分位数。最高四分位数代表最弱势个体。长期新冠定义为自我报告的症状持续三个月或更长时间。使用加权逻辑回归模型来检验这种关联，并对人口统计学和临床变量进行调整。
累积社会劣势处于最高四分位数的成年人与处于最低四分位数的成年人相比，经历长期新冠的几率增加（调整后比值比[AOR]=2.52，95%置信区间[Cl]：2.13，2.98）。这种关联在各人口亚组中均持续存在，在女性和非西班牙裔黑人中影响尤为明显。西班牙裔和非西班牙裔白人的关联较弱，但仍具有统计学意义。关键因素包括心理健康问题、经济不稳定和医疗保健获取障碍。此外，累积社会劣势与长期新冠患者的一般健康状况为中等或较差有关。
本研究强调了累积社会劣势与长期新冠之间的正相关关系。通过综合公共卫生策略解决系统性不平等对于减轻长期新冠的负担和减少健康方面的社会差距至关重要。
