In a recent study published in the journal JAMA Network Open, researchers investigated whether coronavirus disease 2019 (COVID-19) severity and symptom persistence impacted the economic conditions of United States (US) families.
Millions of US adults have experienced COVID-19-related hospitalizations and activity-limiting post-COVID-19 conditions (PCCs). Severe COVID-19 and PCCs can have significant economic consequences, with symptoms affecting daily functioning, job loss, and household finances being further stressed. Low-income families may experience more severe COVID-19 implications due to fewer resources to buffer against financial shocks. However, data on the associations between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and PCCs with family finances are limited.
Study: Association of Severe COVID-19 and Persistent COVID-19 Symptoms With Economic Hardship Among US Families. Image Credit: eldar nurkovic / Shutterstock
About the study
In the present cohort study, researchers examined associations between SARS-CoV-2-related financial difficulties and pre-COVID-19 socioeconomic conditions among US families.
The researchers analyzed the Panel Study of Income Dynamics (PSID) 2019 and 2021 national-level study data, including 6,932 active families. The PSID-2021 survey was conducted between 19 March and 31 December 2021, and the PSID-2021 Early Release file included data from 8,468 families in PSID research in 2019 and two years later. The team merged post-pandemic measures of family economic hardship and COVID-19-associated health outcomes with pre-COVID-19 sociodemographic characteristics.
The researchers defined exposure categories according to the reference individual's, partner's, or spouse's SARS-CoV-2 infection status, symptom duration, and prior history of mild-moderate or severe SARS-CoV-2 infection. Outcomes included COVID-19-related furloughed or laid-off family members, lost earnings, and financial difficulties.
The team examined three indicators of family-level financial difficulties reported by the reference individual in the PSID-2021 survey: a family member furloughed or laid off due to COVID-19, a family member lost earnings due to COVID-19, and a family member had financial struggles due to COVID-19. They obtained COVID-19 severity and symptom duration data for the reference individual, spouse, or partner.
The researchers identified closely related indicators of economic hardship collected in the PSID-2019, such as whether the reference individual, spouse, or partner missed work since they were temporarily laid off, total family labor income or any family member had a credit card or store card debt. Multinomial logistic regression modeling was performed for analysis, and adjusted odds ratios (AORs) were calculated. The PSID-2019 team analyzed sociodemographic characteristics such as the presence of children under 16, the reference individual's age, self-reported race and ethnicity, education attainment, total family income, poverty thresholds, health insurance absences in the past two years, geographic region, and nonmetropolitan residence in a nonmetropolitan area. They excluded families with missing sociodemographic or economic data and indeterminate SARS-CoV-2 exposure.
Results
Among 6,932 families, the likelihood of facing economic hardship was higher for households managed by adults with persistent SARS-CoV-2 infection symptoms and, although to a lower extent, those headed by adults with prior severe SARS-CoV-2 infection history than those without prior COVID-19 history. Households with lower incomes in pre-pandemic times were more susceptible to job disruptions and loss of earnings related to adult household member's SARS-CoV-2 infection status. Among 6,932 families, 772 (14%) included Hispanic individuals, 2,725 (13%) included black individuals of non-Hispanic ethnicity, and 3,242 (67%) included white individuals of non-Hispanic ethnicity.
Nearly one in four [2,222 (27%)] reported household income lower than 200.0% of the United States Census Bureau cut-off for poverty. Regression modeling adjusting for pre-COVID-19 sociodemographic variables and economic hardship experiences, the likelihood of reporting COVID-19-related financial hardship was two- to four-fold higher among households managed by adult individuals with persistent SARS-CoV-2 infection symptoms [furloughed or laid-off: AOR, 2.0; lost income: AOR, 2.9; economic hardship: AOR, 3.7) and two-fold higher among those managed by adults with prior history of severe SARS-CoV-2 infection (furloughed or laid-off: AOR, 1.7; lost income: AOR, 2.0; economic hardship: AOR, 1.9) compared to those without prior COVID-19 history.
Families managed by adults with persistent SARS-CoV-2 infection symptoms were likely to report economic struggles due to COVID-19 irrespective of pre-COVID-19 socioeconomic conditions (lower-income households: AOR, 3.7; higher-income households: AOR, 3.7). Severe SARS-CoV-2 infection history was significantly related to economic hardships among lower-income households (AOR, 2.6); however, no significant associations were observed with financial struggles in higher-income families (OR, 1.6).
Overall, the study findings showed that persistent symptoms of SARS-CoV-2 infection and, although to a lower extent, prior severe SARS-CoV-2 infection history were related to an increased likelihood of COVID-19-associated financial difficulties among United States families. The financial implications of SARS-CoV-2 infection varied by socioeconomic level; households with lower household income in pre-pandemic times were more susceptible to job disruptions and income losses related to SARS-CoV-2 infections among adult family members. The findings indicate that policy actions to mitigate PCC-related household financial hardship merit continued discussion.