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Three cross-sectional data on daily emergency and outpatient were included pre, during and post COVID-19 epidemic. We recorded the number of OME and symptoms and confirmed SARS-Cov-2 infection in patients with OME. We used logistic regression to evaluate the odds ratio (OR) for OME with COVID-19 infection, and employed an interrupted time series analysis to quantify the effect of COVID-19 outbreak on OME, and a time-stratified case-crossover analysis to evaluate the association of OME with SES before, during and after the COVID-19 outbreak, especially in the two months following the COVID-19 outbreak. During COVID-19 outbreak, the OME significantly increased by 50% (RR: 1.563, 95% CI 1.256\u20131.942) compared to the same period in other years, low SES was associated with an increased risk of OME, but this low SES-related risk elevation significantly increased during the outbreak of COVID-19, especially in the first month after COVID-19 infection. Individuals under 50\u00a0years old were still vulnerable to SES after COVID-19 infection in Liaoning. Lower SES might aggravate OME and greater efforts are needed to improve SES in post-COVID-19.<\/jats:p>","DOI":"10.1038\/s41598-026-61832-9","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T14:14:14Z","timestamp":1783606454000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Lower socioeconomic status strengthens the risk of otitis media with effusion after COVID-19 infection: a case-crossover study in Northeast China"],"prefix":"10.1038","volume":"16","author":[{"given":"Ruiyang","family":"Ma","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Tian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Shao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaxing","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuhan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lifeng","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuai","family":"Hao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"issue":"13","key":"61832_CR1","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1056\/NEJMoa2001316","volume":"382","author":"Q Li","year":"2020","unstructured":"Li, Q. et al. 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