Recent research is shedding light on the profound connection between long COVID and social determinants of health (SDOH), revealing that non-medical factors play a significant role in who develops persistent symptoms. This association was highlighted by Ian Kingsbury, who noted in a recent tweet, "In the study, researchers explore associations between long COVID and social determinants of health (SDOH)." He further clarified that SDOH, which he suggests "really should be called social associations of health," refer to non-medical factors like income and education that influence health outcomes.
Numerous studies corroborate that long COVID disproportionately affects individuals based on their social and economic circumstances. Factors such as income, education level, race, ethnicity, and living conditions—including housing stability and exposure to environmental hazards—are increasingly recognized as critical in determining an individual's susceptibility to and recovery from long COVID. These elements create health disparities that were exacerbated by the COVID-19 pandemic.
Research published in journals like Frontiers in Public Health and Annals of Internal Medicine confirm that social risk factors at the time of infection significantly increase the likelihood of developing long COVID. The World Health Organization (WHO) defines long COVID as symptoms that persist for at least three months after initial SARS-CoV-2 infection, with no other explanation. Up to 45% of individuals who survive COVID-19, regardless of hospitalization status, continue to experience unresolved post-COVID symptoms after four months.
The recognition of SDOH's impact has led to calls for more equitable healthcare and support systems. Organizations such as the American Academy of Physical Medicine and Rehabilitation (AAPM&R) have issued guidance emphasizing the consideration of SDOH in assessing and managing COVID-related symptoms. Furthermore, the White House has released a "U.S. Playbook to Address Social Determinants of Health," aiming to foster community partnerships for more equitable public health outcomes.
Addressing these underlying social factors is crucial for mitigating the long-term health consequences of the pandemic and ensuring a more equitable recovery. Continued research and policy interventions focused on these "social associations of health" are essential to understand and alleviate the disproportionate burden of long COVID on vulnerable populations.