The chances of developing long COVID are a lot higher in West Virginia, at 18.2%, than in Maryland, at 12.2%, according to a recent analysis of the Census Bureau's ongoing survey measuring the pandemic's impact.
States like Idaho, at 16.2%; Mississippi, at 17.2%; and Kentucky, at 15.9% report higher rates of long COVID than do states like Delaware, at 11.5%; Vermont, at 10.8%; and Hawaii, at 11%.
In states with lower rates of long COVID, the percentage of people currently experiencing the condition is between 4% and 6%, and between 8% and 9% of those higher long-COVID rates have not recovered.
The analysis, published in the PLOS ONE journal, also found that people struggling with long COVID are more likely to report mental health or mobility problems, according to the analysis.
The findings, researchers said, have significant implications for patients and doctors who treat people with long COVID. Though it is difficult to identify a single reason for the state and regional variations in long-COVID rates, poverty and overall wellness seem to be factors, experts say. Many of the same states that do poorly on those scores have higher long-COVID rates.
To reach his conclusions, lead researcher David Blanchflower, PhD, MSc, MBE, an economics professor at Dartmouth College, examined the Census Bureau's Household Pulse Survey and broke long COVID down by state, income, race, and gender. Interested in measures of happiness and well-being, he looked at mobility and mental health measures as well.
"[There is] immense concern at the health and wellbeing consequences of long COVID," he reported on his findings.
The Census Bureau's Pulse Survey started in March of 2020 to measure the social impact of the pandemic, and the agency gradually added questions about long COVID, he noted.
Blanchflower's analysis also found that:
- Long-COVID rates were higher for women than for men and were higher among White patients compared with Black and Asian patients.
- Rates were lower for those with more education and income.
- Having an income of more than $200,000 seemed to have the most protective effect. In that group, 9.3% developed long COVID, and 4.3% still have it, which is fewer than most states and other income groups. The lower the income, the higher the risk for long COVID, thus suggesting access to affordable healthcare might be a factor for lower-income individuals. Among those with an income of less than $25,000 per year, 16% developed long COVID, including 8% who still have the conditions.
The state-by-state breakdown of long-COVID data corresponds with other state measures of health and well-being, Blanchflower said. The same states that had higher rates of long COVID — Alabama, Mississippi and West Virginia — were also the states that did poorly in Blanchflower's previous research into happiness. The same states also ranked poorly on a wellness index generated by the Boston University School of Public Health.
It's the same states in the Southeast and Midwest that come up short on health measures, said Marcus Plescia, MD, MPH, the chief medical officer of the Associations of State and Territorial Health Officers. People are more likely to die of cancer or heart disease in those states.
"That is kind of consistent with any health problem," he said. "We always see a bigger burden in the Southeast and Midwest. These are areas that are not affluent, and you have more pockets of poverty."
Plescia doesn't think that COVID outcomes can be tied to public health measures debated during the pandemic. There are too many variables, he said.
"There's no real clear story on that," Plescia said. " And there's so many factors that play into it."
It was earlier research linking acute COVID and unusually poor mental health outcomes for young people that led Blanchflower to look at those links in his new research , he said. He measured well-being by looking at response to a series of four questions.
"Over the last 2 weeks, how often have you been bothered by:
- Feeling nervous, anxious, or on edge?
- Not being able to stop or control worrying?
- By feeling down, depressed, or hopeless?
- Bothered by having little interest or pleasure in doing things?"
He found that long COVID is strongly associated with mental health problems like anxiety, depression, and worry. He also found that the correlation was strongest among those who currently report having long COVID.
"Ever having had long COVID is strongly associated with negative affect (anxiety, depression, worry and a lack of interest in things), with the correlation being strongest among those who currently report long COVID, especially if they report severe symptoms," he writes.
He also looked at data on four other symptoms of long COVID: difficulty walking or climbing stairs, difficulties washing or dressing, memory problems, and confusion.
The result were similar: "[Long COVID,] especially with current symptoms generates a significantly higher probability of facing the two physical and two mental health difficulties."
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