Long COVID symptoms vary by race, ethnicity

Black and Hispanic individuals were more likely to experience long COVID-related symptoms and health problems compared with white individuals, according to a new study.

“This new evidence suggests that there may be important differences in how long COVID manifests in different racial and ethnic groups,” Mitchell S.V. Elkind, MD, a professor of neurology and epidemiology at Columbia University, said in a press release. “However, further research is needed to better understand the mechanisms for these differences in symptoms and access to care, and also if diagnostic codes assigned by clinicians may play a role.”

The retrospective cohort study was funded by the NIH as part of its Researching COVID to Enhance Recovery, or RECOVER, initiative.

The COVID-19 pandemic has highlighted substantial racial and ethnic disparities in health care, including greater rates of COVID-19-related mortality among Black patients.

However, “less is known about whether disparities exist with regard to the risk of developing new symptoms or conditions after acute COVID-19,” Dhruv Khullar, MD, an assistant professor of health policy and economics at Weill Medical College, and colleagues wrote in the Journal of General Internal Medicine.

The researchers examined the health records of 62,339 persons in New York City who were diagnosed with COVID-19 between March 2020 and October 2021. Of those patients, 20.3% were Black and 32.7% were Hispanic.

The conditions of patients with COVID-19 were tracked from 1 to 6 months after a positive test and then compared with 247,881 persons who did not have COVID-19 over the study timeframe.

Overall, 13,106 patients had severe COVID-19 that required hospitalization. Severe disease was more common among Black (one in four) and Hispanic (one in four) adults compared with white (one in seven) adults, according to the release.

Up to 180 days after testing positive, Black patients who had severe COVID-19 had higher odds of being diagnosed with chest pain (OR = 1.61; 95% CI, 1.28-2.02), diabetes (OR = 1.96; 95% CI, 1.5-2.56) and headaches (OR = 1.52, 95% CI, 1.11-2.08) compared with white patients.

Meanwhile, Hispanic patients who had severe COVID-19 were also more likely to be diagnosed with headaches (OR = 1.62; 95% CI, 1.21-2.17) as well as dyspnea (OR = 1.22; 95% CI, 1.05-1.42) compared with white patients.

Disparities were also apparent in mild to moderate long COVID symptoms. Among those who did not require hospitalization, Hispanic patients were more likely to be diagnosed with headaches (OR = 1.41; 95% CI, 1.24-1.6) and chest pain (OR = 1.5; 95% CI, 1.35-1.67), while Black patients had a greater likelihood of developing diabetes (OR = 2.13; 95% CI, 1.75-2.58), chest pain (OR = 1.34; 95% CI, 1.18-1.51), malnutrition (OR = 1.95; 95% CI, 1.43-2.66) and pulmonary embolism (OR = 1.68; 95% CI, 1.2-2.36), compared with non-hospitalized white patients. Both Black (OR = 0.58; 95% CI, 0.45-0.75) and Hispanic (OR = 0.64; 95% CI, 0.51-0.8) patients had lower odds of being diagnosed with encephalopathy than white patients.

Khullar and colleagues wrote that the exact reasons behind these patterns were unclear; however, they suggested that the higher rates of severe COVID-19 among Black and Hispanic patients may have increased their risk for long COVID symptoms.

“These populations may also experience higher risk of viral exposure and poorer access to timely medical care, which may lead to more severe acute illness and more long-term sequelae,” they wrote.

Other possible causations include past disparities in COVID-19 immunization rates and Black and Hispanic persons having lower socioeconomic and health statuses, putting them at higher risk for long-term conditions.

“We hope this work draws attention to possible differences across racial and ethnic groups, stimulates research into the potential mechanisms, and sparks discussion among patients, clinicians, and policymakers,” Khullar said in the release.

References:

Khullar D, et al. J Gen Intern Med. 2023;doi:10.1007/s11606-022-07997-1.

NIH RECOVER research identifies potential long COVID disparities. https://www.nih.gov/news-events/news-releases/nih-recover-research-identifies-potential-long-covid-disparities. Published Feb. 16, 2023. Accessed Feb. 22, 2023.