Study Reveals Social Factors that May Triple the Risk of Long Covid - Video

A new nationwide study led by investigators at Mass General Brigham has revealed that social risk factors such as financial hardship, food insecurity, and limited access to healthcare are significantly associated with a higher risk of developing long COVID. The findings, published in the Annals of Internal Medicine, offer vital insights into the long-term impact of the COVID-19 pandemic and underscore the need to address social determinants of health in efforts to combat long COVID.

Long COVID refers to a broad spectrum of symptoms that persist for three months or more following a SARS-CoV-2 infection. While scientific understanding of the condition has grown through the National Institutes of Health’s RECOVER (Researching COVID to Enhance Recovery) Initiative, the influence of social factors has remained less clear—until now.

To better understand this relationship, researchers analyzed data from 3,700 participants in the RECOVER-Adult cohort. These individuals had contracted COVID-19 during the Omicron variant surge and completed comprehensive surveys at the time of infection and again six months later to assess for long COVID symptoms. Participants came from 33 states, Washington, D.C., and Puerto Rico, and enrolled between October 2021 and November 2023.

The researchers assessed four major categories of social risk: economic instability, education and language barriers, healthcare access and quality, and lack of community support. They also used ZIP code-level data to measure factors like household crowding.

After accounting for variables such as vaccination status, hospitalization, age, sex, and race, the study found that nearly all individual-level social risk factors were strongly associated with a two- to three-fold increase in the likelihood of developing long COVID. Living in more crowded areas further raised the risk. The burden of these risk factors was higher among racially and ethnically minoritized groups, but their impact on long COVID risk was consistent across all racial categories.

"While rates of COVID-19 have decreased, long COVID is a chronic disease that many people still suffer from," said senior author Dr. Elizabeth Karlson. "Future interventions must address these factors to effectively reduce adverse outcomes among people with high burden of social risk factors."

Researchers plan to expand the study to assess whether these trends hold for children and explore long COVID symptoms lasting a year or more.

References: Candace H. Feldman, Leah Santacroce, Ingrid V. Bassett, et al. Social Determinants of Health and Risk for Long COVID in the U.S. RECOVER-Adult Cohort. Ann Intern Med. [Epub 29 July 2025]. doi:10.7326/ANNALS-24-01971