Understanding how social determinants of health shape Long COVID outcomes: a rapid review of evidence

Long COVID affects over 65 million people worldwide, yet the impact of social determinants of health (SDoH), such as socioeconomic status, race/ethnicity, education, occupation, and geography, remains poorly understood. To evaluate the association between SDoH and the risk and severity of Long COVID.

A rapid review of observational studies was conducted using MEDLINE, Embase, and Web of Science (up to September 29, 2024). Studies reporting original data on SDoH and Long COVID outcomes were included. Data were extracted on study characteristics, population demographics, Long COVID definitions, and SDoH-related findings. Study quality was assessed using the Newcastle-Ottawa Scale.

Seventy-one studies (43 cohort, 28 cross-sectional) were included. Definitions of Long COVID varied. Commonly studied SDoH included age, sex, race/ethnicity, education, financial security, employment, and geography. Female sex and older age were consistently associated with increased risk and severity of Long COVID. Black and Hispanic individuals were more likely to experience Long COVID. Lower education and financial insecurity were also linked to greater prevalence and symptom burden. Frontline and essential workers were found to be at increased risk. Geographic disparities were evident but varied across rural and urban residence.

SDoH play a key role in shaping Long COVID outcomes. Addressing these disparities requires targeted public health efforts and standardized case definitions.