New evidence shows long Covid health sacrifices across all US states

The symptoms after prolonged are more than nuisance, with poor physical, mental and routine functioning across all US states, highlighting the urgent need for targeted care and recovery strategies.

study: Health-related quality of life among post-covid survivors in the United States. Image credit: p.ill.i / shutterstock

A recent study published in the journal PLOS 1a group of researchers assessed how post-coronavirus disease (COVID) status (PCC) affects health-related quality of life (HRQL) in US Covid-19 survivors.

background

For millions of Americans, recovery from Covid-19 is just the beginning. One in four survivors experience prolonged symptoms such as fatigue, brain fog, dizziness and pain, which lasts for several months and interferes with daily life. These lasting effects, known as PCCS, are often unaware as public attention shifts to infection control. Early studies suggest that PCCS is present in individuals, but the complete impact on health-related quality of life remains poorly understood. There is an urgent need to identify who is at most at risk and how it is best to support them in order to guide effective treatments and policies.

About the research

Researchers analyzed data from the 2022 Behavioral Risk Factor Monitoring System (BRFSS), a national survey led by the Centers for Disease Control and Prevention (CDC). They focus on individuals who previously tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), except for home diagnosis or incomplete responses. Participants were divided into two groups. Anything that reports PCC is defined as being defined as symptoms that persist at least three months after acute Covid-19.

The main outcome was health-related quality of life (HRQL), assessed by four self-report measures: general health, mental health, physical health, and daily functional ability. Sociodemographic characteristics, comorbidities, and behavioral habits (such as physical activity, smoking, and sleep patterns) were also recorded. Advanced statistical techniques including multivariate logistic regression and data assignment via random forest modeling were used to adjust for missing data and confounders. Survey weights and design adjustments were applied to reflect the US adult population. The association between PCCS and adverse self-reported general health (SRGH) was analyzed after considering all related variables.

Researchers noted that BRFSS relied on self-reported data. This can lead to recall bias or report inaccuracy. Additionally, several variables that could affect PCC risk and outcomes, such as vaccination status, drugs, or timing and severity of early COVID-19 infection, were not available in the data set. Institutionalized individuals were not included in the survey, and HRQL questions were not based on standardized surveys. These limitations should be taken into consideration when interpreting the findings of the study.

Research Results

The study included 108,237 adults with confirmed SARS-COV-2 infections, representing more than 70 million Americans. Of these, 22.7% experienced PCC. Individuals with PCC were female, middle-aged, obese, physically inactive, and were more likely to report lower income and poor sleep habits.

Overall, 25.7% of people with PCCS rated their general health as “fair” or “poor” compared to 15.5% of people without PCC. These individuals also reported increased poor mental and physical health and greater disruption in daily activities. In the adjusted regression model, having PCCS is a 39% higher chance of unfavourable general health (adjusted odds ratio) [aOR]: 1.39, 95% confidence interval [CI]:1.28–1.52, p <0.001).

When examining symptoms, dizziness in standing position (38%), mood disorders (36.3%), and musculoskeletal pain (34.1%) were most strongly associated with reduced health ratings. Conversely, symptoms such as loss of taste and odor were less likely to damage overall well-being. In particular, the association between PCCS and low HRQL remains important in all age groups and states, suggesting a widespread and systematic burden.

Among those with PCCS, further analysis revealed that certain factors increase the risk of general health decline. These included late middle age (ages 45–64, AOR = 1.47), obesity (AOR = 1.27), physical inactivity (AOR = 1.94), or too little sleep (AOR = 1.55 and 2.15, respectively). Chronic conditions such as diabetes (AOR = 2.29), heart disease (AOR = 2.01), and lung disease (AOR = 1.98) also significantly increased the likelihood of adverse health. Socioeconomic factors such as lower education and income, single marriage status status, and Hispanic ethnicity were independently associated with worse outcomes.

Interestingly, although women with PCC were more likely to report poor health, gender was not a significant factor after statistical adjustment. State-level analysis reported the highest rates of general health disorders in areas such as West Virginia, Kentucky and Oregon, highlighting geographical disparities in the effects of long symbiosis.

This study also highlighted that PCC is more common among younger adults, but the association between PCCS and quality of life disorders is particularly strong among late middle age (ages 45-64). This highlights the complex relationship between age, risk of PCC and its impact on daily functioning.

Conclusion

In summary, post-Covid conditions significantly reduce health-related quality of life across the United States, affecting physical, mental and everyday functions. Individuals with chronic disease, obesity, reduced socioeconomic status, or unhealthy lifestyle habits are particularly vulnerable. These findings highlight the need for an interdisciplinary care model, long-term monitoring, and targeted rehabilitation strategies for Covid-19 survivors. The authors also seek further research to better understand and address current data source limitations and optimize support for those living with PCC. As the sharp phase of the pandemic recedes, addressing the hidden burden of the PCC will become essential to the national health plan.