Long COVID may be more common in school-aged children whose families experience financial instability and challenging social conditions, University of California–led researchers write in JAMA Pediatrics.
The team analyzed data from the federally funded Researching COVID to Enhance Recovery (RECOVER) Initiative among a subset of 903 US children aged 6 to 11 years and 3,681 adolescents aged 12 to 17 previously infected with SARS-CoV-2 and recruited from 52 health care and community settings.
Their caregivers completed surveys from March 2022 to August 2024. The average age of all participants was 14 years, 51% were boys, and more than half were infected in the pre-Omicron era.
Potential long-term physical, mental effects
The study examined associations between long COVID and 24 social risk factors grouped into five domains: economic stability (eg, food insecurity, poverty); social and community context (eg, caregiver marital status, discrimination); caregiver education access and quality; neighborhood and built environment; and health care access and quality.
Participants were grouped into classes from lowest to highest average proportion across all social determinants of health (SDOH) factors. The reference class (class 1) represented those with the fewest adverse factors, and the class with the highest class number including those with the most adverse factors.
Long COVID is especially concerning in pediatric populations because of the potential for long-term physical and mental health effects that could persist into adulthood.
Each class was characterized by different SDOH factors. For example, in the economic stability domain, class 2 was largely characterized by difficulty covering expenses, class 3 by receipt of food assistance, and class 4 by food insecurity, income less than 120% of the federal poverty level, difficulty covering expenses, and receipt of government assistance.
“Millions of children worldwide are experiencing prolonged symptoms after SARS-CoV-2 infection, yet social risk factors for developing long COVID are largely unknown,” the study authors wrote. “Long COVID is especially concerning in pediatric populations because of the potential for long-term physical and mental health effects that could persist into adulthood.”
Food security a protective factor
After adjusting for confounding factors, economic instability (including food insecurity) was tied to a more than double risk of long COVID (class 2 adjusted odds ratio [aOR], 1.57; class 4 aOR, 2.39), but economic instability without food insecurity (class 3) was not (aOR, 0.93).
The investigators propose that healthy diets may protect against long COVID by reducing inflammation but said that more research is needed on whether addressing adverse social factors can lower future disease risk.
Poorer social and community context (eg, high levels of discrimination and low social support) was also linked to long COVID (aOR, 2.17). Sensitivity analyses stratified by age-group and adjusted for race didn’t change these results.
"Public health interventions that target social risk factors—such as food insecurity and lack of social support—are critical to reduce the burden of long COVID and safeguard the overall health of children as they continue to acquire COVID-19,” co-first author Tanayott Thaweethai, PhD, of Massachusetts General Hospital Biostatistics, said in a Brigham and Women’s Hospital news release.
