{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T21:18:10Z","timestamp":1789507090919,"version":"build-2803163510"},"reference-count":68,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Pediatr"],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"<jats:sec id=\"ab-poi250076-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Millions of children worldwide are experiencing prolonged symptoms after SARS-CoV-2 infection, yet social risk factors for developing long COVID are largely unknown. As child health is influenced by the environment in which they live and interact, adverse social determinants of health (SDOH) may contribute to the development of pediatric long COVID.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-poi250076-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify whether adverse SDOH are associated with increased odds of long COVID in school-aged children and adolescents in the US.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-poi250076-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This cross-sectional analysis of a multicenter, longitudinal, meta-cohort study encompassed 52 sites (health care and community settings) across the US. School-aged children (6-11 years; n\u2009=\u2009903) and adolescents (12-17 years; n\u2009=\u20093681) with SARS-CoV-2 infection history were included. Those with an unknown date of first infection, history of multisystem inflammatory syndrome in children, or symptom surveys with less than 50% of questions completed were excluded. Participants were recruited via health care systems, long COVID clinics, fliers, websites, social media campaigns, radio, health fairs, community-based organizations, community health workers, and existing research cohorts from March 2022 to August 2024, and surveys were completed by caregivers between March 2022 and August 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-poi250076-7\">\n                    <jats:title>Exposure<\/jats:title>\n                    <jats:p>Twenty-four individual social determinant of health factors were grouped into 5 Healthy People 2030 domains: economic stability, social and community context, caregiver education access and quality, neighborhood and built environment, and health care access and quality. Latent classes were created within each domain and used in regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-poi250076-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Presence of long COVID using caregiver-reported, symptom-based, age-specific research indices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-poi250076-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean (SD) age among 4584 individuals included in this study was 14 (3) years, and 2330 (51%) of participants were male. The number of latent classes varied by domain; the reference group was the class with the least adversity. In unadjusted analyses, most classes in each domain were associated with higher odds of long COVID. After adjusting for many factors, including age group, sex, timing of infection, referral source, and other social determinant of health domains, economic instability characterized by difficulty covering expenses, poverty, receipt of government assistance, and food insecurity were associated with an increased risk of having long COVID (class 2 adjusted odds ratio [aOR], 1.57; 95% CI, 1.18-2.09; class 4 aOR, 2.39; 95% CI, 1.73-3.30); economic instability without food insecurity (class 3) was not (aOR, 0.93; 95% CI, 0.70-1.23). Poorer social and community context (eg, high levels of discrimination and low social support) was also associated with long COVID (aOR, 2.17; 95% CI, 1.77-2.66). Sensitivity analyses stratified by age group and adjusted for race and ethnicity did not alter or attenuate these results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-poi250076-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this study, economic instability that included food insecurity and poor social and community context were associated with greater odds of pediatric long COVID. Those with food security, despite experiencing other economic challenges, did not have greater odds of long COVID. Further study is needed to determine if addressing SDOH factors can decrease the rate of pediatric long COVID.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamapediatrics.2025.5485","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T16:00:33Z","timestamp":1767628833000},"page":"275","source":"Crossref","is-referenced-by-count":5,"title":["Social Determinants of Health and Pediatric Long COVID in the US"],"prefix":"10.1001","volume":"180","author":[{"given":"Kyung E.","family":"Rhee","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Child and Community Health, University of California San Diego School of Medicine, Rady Children\u2019s Hospital, San Diego"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanayott","family":"Thaweethai","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital Biostatistics, Boston"},{"name":"Department of Medicine, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepti B.","family":"Pant","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital Biostatistics, Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl R.","family":"Stein","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy L.","family":"Salisbury","sequence":"additional","affiliation":[{"name":"School of Nursing, Virginia Commonwealth University, Richmond"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia A.","family":"Kinser","sequence":"additional","affiliation":[{"name":"School of Nursing, Virginia Commonwealth University, Richmond"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence C.","family":"Kleinman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Population Health, Quality, and Implementation Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey"},{"name":"Bristol Myers Squibb Children\u2019s Hospital, New Brunswick, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Gallagher","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Child Study Center, New York University Grossman School of Medicine, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Warburton","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Children\u2019s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sindhu","family":"Mohandas","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Infectious Diseases, Children\u2019s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica N.","family":"Snowden","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Infectious Diseases, University of Arkansas for Medical Sciences, Little Rock"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa S.","family":"Stockwell","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Child and Adolescent Health, Columbia University Vagelos College of Physicians and Surgeons, New York, New York"},{"name":"Department of Population and Family Health, Mailman School of Public Health; New York-Presbyterian Hospital, New 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