Study finds potential racial and ethnic disparities in long COVID symptoms

Black and Hispanic patients were more likely than white patients to develop a wide array of lasting symptoms and conditions after a COVID-19 diagnosis, according to a new study led by Weill Cornell Medicine and NewYork-Presbyterian investigators.

The study, published in the Journal of General Medicine on Feb. 16, adds to a growing body of evidence demonstrating profound racial and ethnic disparities in the impact of COVID-19 in the United States. Previous research showed a higher rate of COVID-19 hospitalizations and deaths among Black and Hispanic individuals than among white individuals. Now investigators have found racial and ethnic differences in the frequency and types of post-acute sequelae of SARS-CoV-2 infection, commonly known as long COVID.

Identifying potential racial and ethnic disparities in long COVID is an important step toward making sure we have an equitable response to the long-term consequences of coronavirus infection."

Dr. Dhruv Khullar, lead author

Dr. Dhruv Khullar, is an assistant professor of Population Health Sciences and the Nanette Laitman Clinical Scholar in Healthcare Policy Research/Quality of Care Research at Weill Cornell Medicine and a hospitalist at NewYork-Presbyterian/Weill Cornell Medical Center.

About one in five individuals experience persistent symptoms or are diagnosed with a new medical condition 30 days after having COVID-19, according to research by the United States Center for Disease Control and Prevention. These symptoms may include shortness of breath, fatigue, cognitive dysfunction, anxiety, blood clots and various other conditions. Older patients and those with pre-existing conditions like type-2 diabetes or autoimmune disorders are at higher risk of lasting complications.

For this study, funded by the National Institutes of Health's Researching COVID to Enhance Recovery (RECOVER) initiative, the investigators examined if the risk and type of post-COVID-19 symptoms varied by racial and ethnic groups. The dataset included 29,331 white patients, 12,638 Black patients, and 20,370 Hispanic patients who tested positive for COVID-19 at one of five academic health systems in New York City between March 2020 and October 2021.

The health records analyzed for the study came from a New York-based network called the INSIGHT Clinical Research Network, which is part of the National Patient-Centered Clinical Research Network (PCORnet). INSIGHT is led by senior author Dr. Rainu Kaushal, senior associate dean for clinical research at Weill Cornell Medicine and chair of the Department of Population Health Sciences at Weill Cornell Medicine and NewYork-Presbyterian/Weill Cornell Medical Center.

"An important goal of our efforts is to shed light on inequities to improve the delivery of care across the country," said Dr. Kaushal, who is also principal investigator on the RECOVER grant, physician-in-chief of population health sciences at NewYork-Presbyterian/Weill Cornell Medical Center and the Nanette Laitman Distinguished Professor of Population Health Sciences at Weill Cornell Medicine.

The team analyzed the likelihood of individuals in the cohort being diagnosed with 137 potential post-COVID-19 symptoms affecting seven organ systems, including nervous, skin, respiratory, circulatory, blood, endocrine and digestive system, as well as general symptoms. They compared these patients' records with records from nearly 250,000 patients who did not have a COVID-19 diagnosis. They also looked at differences between patients who had required hospitalization and those who did not.

Among patients with COVID-19 who were not hospitalized, Hispanic patients had greater odds of developing new symptoms affecting six of the eight symptom categories than white patients. Black patients had higher odds of experiencing symptoms affecting four symptom categories than their white counterparts. The types of symptoms reported also varied among the groups. For instance, Black patients had elevated odds of developing blood clots in the lungs or of being diagnosed with diabetes after COVID-19 than white patients. Hispanic patients had higher odds of having headaches or chest pain than white patients. White patients had higher odds of abnormal brain function or damage to the brain.

Hospitalized patients overall had higher rates of long COVID symptoms than patients who weren't hospitalized, said Dr. Khullar. The team also found pronounced racial and ethnic disparities in symptoms among hospitalized patients. Black patients hospitalized with COVID-19 were twice as likely to be later diagnosed with diabetes and 1.5 times as likely to be diagnosed with chest pain in the first six months after hospitalization compared with white patients. Hispanic patients hospitalized with COVID-19 were 1.6 times as likely to develop headaches and 1.65 times as likely to develop chest pain after COVID-19 than white patients.

The study can't explain why there were differences in risk levels or symptoms among racial and ethnic groups, Dr. Khullar said. More studies are needed to understand the causes and mechanisms for the observed differences, and to see if similar differences exist in other parts of the country. But in the meantime, Dr. Khullar encouraged clinicians to try to mitigate the impact of disparities in long COVID by ensuring equitable access to care and enrolling diverse cohorts of patients in clinical trials.

"We hope our study encourages clinicians, researchers and policymakers to pay attention to potential differences in long COVID across racial and ethnic groups and to stimulate more research and discussion," Dr. Khullar said.