How common are COVID-19 symptoms lasting longer than 2 months, also known as long COVID, among adults in the United States, and which adults are most likely to experience long COVID?
In this cross-sectional study of more than 16 000 individuals, 15% of US adults with a prior positive COVID-19 test reported current symptoms of long COVID. Those who completed a primary vaccination series prior to infection were less likely to report long COVID symptoms.
This study suggests that long COVID is prevalent and that the risk varies among individual subgroups in the United States; vaccination may reduce this risk.
Persistence of COVID-19 symptoms beyond 2 months, or long COVID, is increasingly recognized as a common sequela of acute infection.
To estimate the prevalence of and sociodemographic factors associated with long COVID and to identify whether the predominant variant at the time of infection and prior vaccination status are associated with differential risk.
Design, Setting, and Participants
This cross-sectional study comprised 8 waves of a nonprobability internet survey conducted between February 5, 2021, and July 6, 2022, among individuals aged 18 years or older, inclusive of all 50 states and the District of Columbia.
Main Outcomes and Measures
Long COVID, defined as reporting continued COVID-19 symptoms beyond 2 months after the initial month of symptoms, among individuals with self-reported positive results of a polymerase chain reaction test or antigen test.
The 16 091 survey respondents reporting test-confirmed COVID-19 illness at least 2 months prior had a mean age of 40.5 (15.2) years; 10 075 (62.6%) were women, and 6016 (37.4%) were men; 817 (5.1%) were Asian, 1826 (11.3%) were Black, 1546 (9.6%) were Hispanic, and 11 425 (71.0%) were White. From this cohort, 2359 individuals (14.7%) reported continued COVID-19 symptoms more than 2 months after acute illness. Reweighted to reflect national sociodemographic distributions, these individuals represented 13.9% of those who had tested positive for COVID-19, or 1.7% of US adults. In logistic regression models, older age per decade above 40 years (adjusted odds ratio [OR], 1.15; 95% CI, 1.12-1.19) and female gender (adjusted OR, 1.91; 95% CI, 1.73-2.13) were associated with greater risk of persistence of long COVID; individuals with a graduate education vs high school or less (adjusted OR, 0.67; 95% CI, 0.56-0.79) and urban vs rural residence (adjusted OR, 0.74; 95% CI, 0.64-0.86) were less likely to report persistence of long COVID. Compared with ancestral COVID-19, infection during periods when the Epsilon variant (OR, 0.81; 95% CI, 0.69-0.95) or the Omicron variant (OR, 0.77; 95% CI, 0.64-0.92) predominated in the US was associated with diminished likelihood of long COVID. Completion of the primary vaccine series prior to acute illness was associated with diminished risk for long COVID (OR, 0.72; 95% CI, 0.60-0.86).
Conclusions and Relevance
This study suggests that long COVID is prevalent and associated with female gender and older age, while risk may be diminished by completion of primary vaccination series prior to infection.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: September 12, 2022.
Published: October 27, 2022. doi:10.1001/jamanetworkopen.2022.38804
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Perlis RH et al. JAMA Network Open.
Corresponding Author: Roy H. Perlis, MD, MSc, Massachusetts General Hospital, 185 Cambridge St, 6th Floor, Boston, MA 02114 (email@example.com).
Author Contributions: Dr Perlis had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Perlis, Safarpour, Druckman, Lazer.
Acquisition, analysis, or interpretation of data: Perlis, Santillana, Ognyanova, Safarpour, Lunz Trujillo, Simonson, Green, Quintana, Baum, Lazer.
Drafting of the manuscript: Perlis, Lazer.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Perlis, Santillana, Green.
Obtained funding: Ognyanova, Druckman, Baum, Lazer.
Administrative, technical, or material support: Perlis, Lunz Trujillo, Simonson, Quintana, Druckman, Lazer.
Conflict of Interest Disclosures: Dr Perlis reported receiving personal fees from Burrage Capital, Genomind, Psy Therapeutics, Takeda, and Circular Genomics outside the submitted work. Dr Lazer reported receiving grants from the National Science Foundation during the conduct of the study. No other disclosures were reported.
Funding/Support: The survey was supported in part by the National Science Foundation (Drs Ognyanova, Druckman, Baum, and Lazer).
Role of the Funder/Sponsor: The National Science Foundation had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Disclaimer: Dr Perlis is associate editor of JAMA Network Open, but he was not involved in any of the decisions regarding review of the manuscript or its acceptance.
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