{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T09:04:14Z","timestamp":1779354254387,"version":"3.51.4"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T00:00:00Z","timestamp":1763078400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T00:00:00Z","timestamp":1763078400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["1RF1MH133436-01"],"award-info":[{"award-number":["1RF1MH133436-01"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["IK2 HX002867"],"award-info":[{"award-number":["IK2 HX002867"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J GEN INTERN MED"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n COVID-19 disproportionately affects racial\/ethnic minorities and economically disadvantaged persons, which may also apply to sequelae from acute infection. Little is known about those who live with post-acute sequelae of SARS-CoV-2 infection (PASC), including long COVID, especially those without a formal diagnosis.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine self-reported long COVID symptoms and its associations with individual and state characteristics from a national survey sample of working-age adults.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Repeated cross-sectional survey analysis.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n Eighteen- to 64-year-old adults who reported ever having had COVID-19 (n\u2009=\u2009409,087).<\/jats:p>\n <\/jats:sec>\n \n Main Measures<\/jats:title>\n We examined long COVID responses from the online Household Pulse Survey (9\/22\/2022\u201310\/30\/2023), administered by the Census Bureau and the National Center for Health Statistics. Long COVID was defined as having \u201csymptoms lasting 3 months or longer that you did not have prior to having coronavirus\u201d (e.g., fatigue, difficulty thinking, shortness of breath) or not. Logistic regression models adjusted for survey week, respondent characteristics (e.g., demographics, acute COVID-19 severity), and state characteristics (e.g., rurality, Health Professional Shortage Areas). We additionally examined concurrent depression and anxiety symptoms.<\/jats:p>\n <\/jats:sec>\n \n Key Results<\/jats:title>\n \n The HPS response rate was 6.10% during the study timeframe.\n 14<\/jats:sup>\n Among those who ever had COVID-19, 27.5% reported long COVID symptoms. Among those with long COVID symptoms, 22.6% reported having severe activity limitations. In fully adjusted models, long COVID symptoms were most commonly reported by Hispanic respondents (\u0394\n P<\/jats:italic>\n H<\/jats:sub>\n \u2009=\u20092.3, SE\u2009=\u20090.7), among all racial-ethnic groups. Low socioeconomic status was consistently associated with long COVID symptoms: Income (\u0394\n P<\/jats:italic>\n <25k vs >=200k+<\/jats:sub>\n \u2009=\u200911.9, SE\u2009=\u20090.9); Medicaid-insurance (\u0394\n P<\/jats:italic>\n Medicaid v Employer-sponsored<\/jats:sub>\n \u2009=\u200902.9, SE\u2009=\u20090.5); Uninsurance (\u0394\n P<\/jats:italic>\n Uninsured v Employer-sponsored<\/jats:sub>\n \u2009=\u20091.8, SE\u2009=\u20090.4). Long COVID symptoms were associated with living in more rural states (\u0394\n P<\/jats:italic>\n \u2009=\u20090.08, SE\u2009=\u20090.02). Long COVID symptoms were additionally associated with concurrent anxiety (\u0394\n P<\/jats:italic>\n Anx v Not<\/jats:sub>\n \u2009=\u20098.0, SE\u2009=\u20090.4) and depressive symptoms (\u0394\n P<\/jats:italic>\n Dep v Not<\/jats:sub>\n \u2009=\u20096.7, SE\u2009=\u20090.6).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Long COVID symptoms and disability were disproportionately reported among survey respondents who were Hispanic and who were economically-disadvantaged. Rural communities were more so impacted.<\/jats:p>\n <\/jats:sec>","DOI":"10.1007\/s11606-025-09912-w","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T18:17:19Z","timestamp":1763144239000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Long COVID Disproportionately Reported by Disadvantaged Individuals: A National Survey of U.S. Working-Age Adults"],"prefix":"10.1007","author":[{"given":"Nicolo A.","family":"Villasis","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jasmeen J.","family":"Santos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan L.","family":"Ettner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haiyong","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 J.","family":"Escarce","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucinda B.","family":"Leung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,11,14]]},"reference":[{"key":"9912_CR1","unstructured":"World Health Organization. A Clinical Case Definition of Post COVID-19 Condition by a Delphi Consensus, 6 October 2021. https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1.\u00a0Accessed 9 October 2025."},{"key":"9912_CR2","doi-asserted-by":"publisher","unstructured":"Fern\u00e1ndez-de-las-Pe\u00f1as C, Palacios-Ce\u00f1a D, G\u00f3mez-Mayordomo V, et al. Prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized COVID-19 survivors: A systematic review and meta-analysis. Eur J Intern Med. 2021;92:55-70. https:\/\/doi.org\/10.1016\/j.ejim.2021.06.009.","DOI":"10.1016\/j.ejim.2021.06.009"},{"key":"9912_CR3","doi-asserted-by":"publisher","unstructured":"Sudre CH, Murray B, Varsavsky T, et al. Attributes and predictors of long COVID. Nat Med. 2021;27(4):626-631. https:\/\/doi.org\/10.1038\/s41591-021-01292-y.","DOI":"10.1038\/s41591-021-01292-y"},{"key":"9912_CR4","doi-asserted-by":"publisher","unstructured":"Ford ND, Slaughter D, Edwards D, et al. Long COVID and Significant Activity Limitation Among Adults, by Age \u2014 United States, June 1\u201313, 2022, to June 7\u201319, 2023. MMWR Morb Mortal Wkly Rep. 2023;72(32):866-870. https:\/\/doi.org\/10.15585\/mmwr.mm7232a3.","DOI":"10.15585\/mmwr.mm7232a3"},{"key":"9912_CR5","doi-asserted-by":"publisher","unstructured":"Ledford H. How common is long COVID? Why studies give different answers. Nature. 2022;606(7916):852-853. https:\/\/doi.org\/10.1038\/d41586-022-01702-2.","DOI":"10.1038\/d41586-022-01702-2"},{"key":"9912_CR6","doi-asserted-by":"publisher","unstructured":"Henning\u2010Smith C, Tuttle M, Kozhimannil KB. Unequal Distribution of COVID\u201019 Risk Among Rural Residents by Race and Ethnicity. J Rural Health. 2021;37(1):224-226. https:\/\/doi.org\/10.1111\/jrh.12463.","DOI":"10.1111\/jrh.12463"},{"key":"9912_CR7","doi-asserted-by":"publisher","unstructured":"Bull-Otterson L, Baca S, Saydah S, et al. Post\u2013COVID Conditions Among Adult COVID-19 Survivors Aged 18\u201364 and \u226565 Years \u2014 United States, March 2020\u2013November 2021. MMWR Morb Mortal Wkly Rep. 2022;71(21):713-717. https:\/\/doi.org\/10.15585\/mmwr.mm7121e1.","DOI":"10.15585\/mmwr.mm7121e1"},{"key":"9912_CR8","doi-asserted-by":"publisher","unstructured":"Ioannou GN, Baraff A, Fox A, et al. Rates and Factors Associated With Documentation of Diagnostic Codes for Long COVID in the National Veterans Affairs Health Care System. JAMA Netw Open. 2022;5(7):e2224359. https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.24359.","DOI":"10.1001\/jamanetworkopen.2022.24359"},{"key":"9912_CR9","doi-asserted-by":"publisher","unstructured":"Tai DBG, Sia IG, Doubeni CA, Wieland ML. Disproportionate Impact of COVID-19 on Racial and Ethnic Minority Groups in the United States: a 2021 Update. J Racial and Ethnic Health Disparities. 2022;9(6):2334-2339. https:\/\/doi.org\/10.1007\/s40615-021-01170-w.","DOI":"10.1007\/s40615-021-01170-w"},{"key":"9912_CR10","doi-asserted-by":"publisher","unstructured":"Yoo SM, Liu TC, Motwani Y, et al. Factors Associated with Post-Acute Sequelae of SARS-CoV-2 (PASC) After Diagnosis of Symptomatic COVID-19 in the Inpatient and Outpatient Setting in a Diverse Cohort. J gen Intern Med. 2022;37(8):1988-1995. https:\/\/doi.org\/10.1007\/s11606-022-07523-3.","DOI":"10.1007\/s11606-022-07523-3"},{"key":"9912_CR11","doi-asserted-by":"publisher","unstructured":"Perlis RH, Santillana M, Ognyanova K, et al. Prevalence and Correlates of Long COVID Symptoms Among US Adults. JAMA Netw Open. 2022;5(10):e2238804. https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.38804.","DOI":"10.1001\/jamanetworkopen.2022.38804"},{"key":"9912_CR12","doi-asserted-by":"publisher","unstructured":"Caz\u00e9 AB, Cerqueira-Silva T, Bomfim AP, et al. Prevalence and risk factors for long COVID after mild disease: A cohort study with a symptomatic control group. J Glob Health. 13:06015. https:\/\/doi.org\/10.7189\/jogh.13.06015.","DOI":"10.7189\/jogh.13.06015"},{"key":"9912_CR13","doi-asserted-by":"publisher","unstructured":"Khullar D, Zhang Y, Zang C, et al. Racial\/ethnic disparities in post-acute sequelae of SARS-CoV-2 infection in New York: an EHR-based cohort study from the RECOVER program. J Gen Intern Med. 2023;38(5):1127-1136. https:\/\/doi.org\/10.1007\/s11606-022-07997-1.","DOI":"10.1007\/s11606-022-07997-1"},{"key":"9912_CR14","unstructured":"U.S. Census Bureau. Household Pulse Survey: Measuring Emergent Social and Economic Matters Facing U.S. Households. https:\/\/www.census.gov\/data\/experimental-data-products\/household-pulse-survey.html.\u00a0Accessed 9 October 2025."},{"key":"9912_CR15","doi-asserted-by":"publisher","unstructured":"Pfaff ER, Madlock-Brown C, Baratta JM, et al. Coding long COVID: characterizing a new disease through an ICD-10 lens. BMC Med. 2023;21(1):58. https:\/\/doi.org\/10.1186\/s12916-023-02737-6.","DOI":"10.1186\/s12916-023-02737-6"},{"key":"9912_CR16","doi-asserted-by":"publisher","unstructured":"Berger Z, Altiery De Jesus V, Assoumou SA, Greenhalgh T. Long COVID and Health Inequities: The Role of Primary Care. Milbank Quarterly. 2021;99(2):519\u2013541. https:\/\/doi.org\/10.1111\/1468-0009.12505.","DOI":"10.1111\/1468-0009.12505"},{"key":"9912_CR17","doi-asserted-by":"publisher","unstructured":"Bartsch SM, Ferguson MC, McKinnell JA, et al. The Potential Health Care Costs And Resource Use Associated With COVID-19 In The United States: A simulation estimate of the direct medical costs and health care resource use associated with COVID-19 infections in the United States. Health Affairs. 2020;39(6):927-935. https:\/\/doi.org\/10.1377\/hlthaff.2020.00426.","DOI":"10.1377\/hlthaff.2020.00426"},{"key":"9912_CR18","doi-asserted-by":"publisher","unstructured":"Ku BS, Druss BG. Associations Between Primary Care Provider Shortage Areas and County-Level COVID-19 Infection and Mortality Rates in the USA. J Gen Intern Med. 2020;35(11):3404-3405. https:\/\/doi.org\/10.1007\/s11606-020-06130-4.","DOI":"10.1007\/s11606-020-06130-4"},{"key":"9912_CR19","doi-asserted-by":"publisher","unstructured":"Sun Y, Monnat SM. Rural\u2010urban and within\u2010rural differences in COVID\u201019 vaccination rates. J Rural Health. 2022;38(4):916-922. https:\/\/doi.org\/10.1111\/jrh.12625.","DOI":"10.1111\/jrh.12625"},{"key":"9912_CR20","doi-asserted-by":"publisher","unstructured":"Laine C, Moyer DV. COVID-19 Is No Longer a Public Health Emergency: Implications for Patients and Clinicians. Ann Intern Med. 2023;176(7):983-984. https:\/\/doi.org\/10.7326\/M23-1338.","DOI":"10.7326\/M23-1338"},{"key":"9912_CR21","doi-asserted-by":"publisher","unstructured":"Taquet M, Dercon Q, Luciano S, Geddes JR, Husain M, Harrison PJ. Incidence, co-occurrence, and evolution of long-COVID features: A 6-month retrospective cohort study of 273,618 survivors of COVID-19. Kretzschmar MEE, ed. PLoS Med. 2021;18(9):e1003773. https:\/\/doi.org\/10.1371\/journal.pmed.1003773.","DOI":"10.1371\/journal.pmed.1003773"},{"key":"9912_CR22","doi-asserted-by":"publisher","unstructured":"Idehen JB, Kazi U, Quainoo-Acquah JA, et al. On Patterns of Neuropsychiatric Symptoms in Patients With COVID-19: A Systematic Review of Case Reports. Cureus. Published online May 15, 2022. https:\/\/doi.org\/10.7759\/cureus.25004.","DOI":"10.7759\/cureus.25004"},{"key":"9912_CR23","doi-asserted-by":"publisher","unstructured":"Walker S, Goodfellow H, Pookarnjanamorakot P, et al. Impact of fatigue as the primary determinant of functional limitations among patients with post-COVID-19 syndrome: a cross-sectional observational study. BMJ Open. 2023;13(6):e069217. https:\/\/doi.org\/10.1136\/bmjopen-2022-069217.","DOI":"10.1136\/bmjopen-2022-069217"}],"container-title":["Journal of General Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11606-025-09912-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11606-025-09912-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11606-025-09912-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T18:17:20Z","timestamp":1763144240000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11606-025-09912-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,14]]},"references-count":23,"alternative-id":["9912"],"URL":"https:\/\/doi.org\/10.1007\/s11606-025-09912-w","relation":{},"ISSN":["0884-8734","1525-1497"],"issn-type":[{"value":"0884-8734","type":"print"},{"value":"1525-1497","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,14]]},"assertion":[{"value":"28 January 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 November 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations:"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human Ethics and Consent to Participate:"}},{"value":"The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the US Department of Veterans Affairs or the US government.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclaimer:"}},{"value":"No disclosures to report.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest Disclosures:"}}]}}