Affiliation:
1. Department of Epidemiology University of Michigan Ann Arbor Michigan USA
2. Department of Epidemiology and Biostatistics Texas A&M University College Station, Texas USA
3. CDC Foundation Atlanta Georgia USA
4. Michigan Department of Health and Human Services Lansing Michigan USA
Abstract
AbstractPurposeTo (1) assess whether residential rurality/urbanicity was associated with the prevalence of 30‐ or 90‐day long COVID, and (2) evaluate whether differences in long COVID risk factors might explain this potential disparity.MethodsWe used data from the Michigan COVID‐19 Recovery Surveillance Study, a population‐based probability sample of adults with COVID‐19 (n = 4,937). We measured residential rurality/urbanicity using dichotomized Rural‐Urban Commuting Area codes (metropolitan, nonmetropolitan). We considered outcomes of 30‐day long COVID (illness duration ≥30 days) and 90‐day long COVID (illness duration ≥90 days). Using Poisson regression, we estimated unadjusted prevalence ratios (PRs) to compare 30‐ and 90‐day long COVID between metropolitan and nonmetropolitan respondents. Then, we adjusted our model to account for differences between groups in long COVID risk factors (age, sex, acute COVID‐19 severity, vaccination status, race and ethnicity, socioeconomic status, health care access, SARS‐CoV‐2 variant, and pre‐existing conditions). We estimated associations for the full study period (Jan 1, 2020‐May 31, 2022), the pre‐vaccine era (before April 5, 2021), and the vaccine era (after April 5, 2021).FindingsCompared to metropolitan adults, the prevalence of 30‐day long COVID was 15% higher (PR = 1.15 [95% CI: 1.03, 1.29]), and the prevalence of 90‐day long COVID was 27% higher (PR = 1.27 [95% CI: 1.09, 1.49]) among nonmetropolitan adults. Adjusting for long COVID risk factors did not reduce disparity estimates in the pre‐vaccine era but halved estimates in the vaccine era.ConclusionsOur findings provide evidence of a rural‐urban disparity in long COVID and suggest that the factors contributing to this disparity changed over time as the sociopolitical context of the pandemic evolved and COVID‐19 vaccines were introduced.
Funder
Centers for Disease Control and Prevention
Michigan Department of Health and Human Services
Subject
Public Health, Environmental and Occupational Health
Reference46 articles.
1. US Centers for Disease Control and Prevention.Long COVID: Household Pulse Survey. Published 2023. Accessed May 2 2023.https://www.cdc.gov/nchs/covid19/pulse/long‐covid.htm
2. US Centers for Disease Control and Prevention.Long COVID or Post COVID Conditions. Published 2022. Accessed February 7 2023.https://www.cdc.gov/coronavirus/2019‐ncov/long‐term‐effects/index.html
3. A clinical case definition of post-COVID-19 condition by a Delphi consensus
4. Post‐acute COVID‐19 syndrome (PCS) and health‐related quality of life (HRQoL)—A systematic review and meta‐analysis
5. Returning to work and the impact of post COVID‐19 condition: a systematic review;Gualano MR;Work,2022