Survey results published today in JAMA Network Open show that US households headed by an adult with long COVID were two to four times more likely to report pandemic-related financial hardships, regardless of prepandemic socioeconomic status.
Researchers from the University of South Carolina and Montana State University administered the Panel Study of Income Dynamics survey to 6,932 families about their financial status before (2019) and during the pandemic (2021). Of the 6,932 families, 13.1% were Black, 13.5% were Hispanic, 66.8% were White, and 27.0% reported incomes below 200% of the US Census Bureau poverty threshold.
"Symptoms of PCCs [post-COVID conditions] can adversely affect daily functioning and have been associated with a lower likelihood of working full time and a higher likelihood of being unemployed," the study authors wrote.
"COVID-19–associated hospitalizations have been similarly associated with job loss. In addition to the direct associations with patients' work and earnings, household finances may be further stressed by out-of-pocket medical expenses and lost caretaker productivity," they added.
17% reported financial problems
More than a fourth of households (28.4%) headed by an adult previously infected by SARS-CoV-2 (1,147 affected families) reported persistent symptoms. The remaining 5,785 families (84.6%) had no history of COVID-19.
Of the 6,932 families, 17.0%, 23.0%, and 16.8% reported that a household member had been laid off or furloughed, lost earnings, or had financial difficulties, respectively, due to the pandemic. Overall, 14.2% had at least one member who lacked health insurance in the past 2 years.
In total, 15.4% of families were headed by an adult (respondent or spouse or partner) who had tested positive for COVID-19, including 4.4%, 3.1%, and 7.9% who had long COVID, severe illness, or moderate, mild, or asymptomatic disease, respectively. There was no statistically significant association between previous moderate, mild, or asymptomatic COVID-19 and layoffs or furloughs (OR, 1.22; AOR, 1.05) or financial problems (OR, 1.05; AOR, 0.91).
Families headed by an adult who was temporarily laid off or furloughed were at higher risk of persistent COVID-19 symptoms (adjusted relative risk ratio [ARRR], 2.82), while families with credit card or store card debt (an indicator of financial difficulties) were at higher risk of moderate, mild, or asymptomatic COVID-19 infection (ARRR, 1.58).
Severe COVID and hardship for low-income families
The likelihood of reporting pandemic-related financial hardships was 2.0 to 3.7 times higher among families headed by an adult with long COVID (adjusted odds ratio [aOR] for laid off or furloughed, 1.98; aOR for lost earnings, 2.86; aOR for financial difficulties, 3.72).
The odds were 1.7 to 2.0 times higher among families headed by a survivor of severe COVID-19 (aOR for laid off or furloughed, 1.69; aOR for lost earnings, 1.99; aOR for financial difficulties, 1.87) compared with families without a history of COVID-19.
Families with lower income before the pandemic (ie, families who had fewer resources available to buffer against COVID-19–related financial shocks) were more vulnerable to employment disruptions and earnings losses associated with an adult family member's COVID-19 illness.
Families headed by an adult with long COVID had higher odds of pandemic-related financial difficulties, regardless of prepandemic socioeconomic status (aOR for lower-income families, 3.71; aOR for higher-income families, 3.74). Previous severe COVID-19 was significantly tied to financial problems in lower-income families (AOR, 2.59) but not in those with higher incomes (OR, 1.56).
"Families with lower income before the pandemic (ie, families who had fewer resources available to buffer against COVID-19–related financial shocks) were more vulnerable to employment disruptions and earnings losses associated with an adult family member's COVID-19 illness," the researchers wrote. "Individuals living in economically vulnerable households are more likely to hold essential jobs, which have been associated with increased employment-related exposure and risk of severe COVID-19 among workers and their household members."
The authors noted that an estimated 3 million to 5 million American adults have activity-limiting long COVID. "Given the significant economic consequences of COVID-19 and the expectation that PCCs will continue to affect individuals and their families over the long term, policy actions to mitigate the household financial impact of PCCs (eg, expanded paid sick leave, improved workplace accommodations, and wider access to disability insurance) merit continued discussion," they wrote.
