Long COVID Appears to Present Differently Based on Patient Race, Ethnicity

Long COVID includes a range of symptoms that patients can have after SARS-CoV-2 infection. Further complicating diagnosis and treatment are new studies that suggest post-acute sequelae of COVID-19 can vary greatly by race, ethnicity and age. Here are more details.

NEW YORK – While Long COVID symptoms appear to be more common in Black and Hispanic patients in the United States, those patients might be less likely to receive diagnoses.

That’s according to new research funded by the National Institutes of Health through its Researching COVID to Enhance Recovery (RECOVER) Initiative.

“This new evidence suggests that there may be important differences in how long COVID manifests in different racial and ethnic groups,” Mitchell S.V. Elkind, MD, a professor of neurology and epidemiology at Columbia University, New York City, and chief clinical science officer for the American Heart Association, said in an NIH press release. “However, further research is needed to better understand the mechanisms for these differences in symptoms and access to care, and also if diagnostic codes assigned by clinicians may play a role.” 

In one analysis, published in the Journal of General Internal Medicine, Weill Cornell Medicine-led researchers sought to examine racial differences in post-acute sequelae of SARS-CoV-2 infection (PASC) among hospitalized and non-hospitalized patients.

https://link.springer.com/article/10.1007/s11606-022-07997-1

For the retrospective cohort study using data from electronic health records, researchers included 62,339 patients with COVID-19 and 247,881 patients without COVID-19 in New York City between March 2020 and October 2021. The final study population included 29,331 white patients (47.1%), 12,638 Black patients (20.3%), and 20,370 Hispanic patients (32.7%) diagnosed with COVID-19.

The focus was on new symptoms and conditions 31–180 days after COVID-19 diagnosis. After adjusting for confounders, results indicate that significant racial/ethnic differences in incident symptoms and conditions existed among both hospitalized and non-hospitalized patients.

“For example,” the authors point out, “31–180 days after a positive SARS-CoV-2 test, hospitalized Black patients had higher odds of being diagnosed with diabetes (adjusted odds ratio [OR]: 1.96, 95% confidence interval [CI]: 1.50—2.56, q<0.001) and headaches (OR: 1.52, 95% CI: 1.11—2.08, q=0.02), compared to hospitalized white patients. Hospitalized Hispanic patients had higher odds of headaches (OR: 1.62, 95% CI: 1.21—2.17, q=0.003) and dyspnea (OR: 1.22, 95% CI: 1.05—1.42, q=0.02), compared to hospitalized white patients.”

In addition, among non-hospitalized patients, Black patients had higher odds of being diagnosed with pulmonary embolism (OR: 1.68, 95% CI: 1.20—2.36, q=0.009) and diabetes (OR: 2.13, 95% CI: 1.75—2.58, q<0.001), but lower odds of encephalopathy (OR: 0.58, 95% CI: 0.45—0.75, q<0.001), compared to white patients, the study notes.

Hispanic patients had higher odds of being diagnosed with headaches (OR: 1.41, 95% CI: 1.24—1.60, q<0.001) and chest pain (OR: 1.50, 95% CI: 1.35—1.67, q < 0.001), but lower odds of encephalopathy (OR: 0.64, 95% CI: 0.51—0.80, q<0.001), the authors state.

“Compared to white patients, patients from racial/ethnic minority groups had significantly different odds of developing potential PASC symptoms and conditions,” the study concludes. “Future research should examine the reasons for these differences.”

“It’s not clear what's behind these symptom variations,” added Dhruv Khullar, MD, a study author and physician and assistant professor of health policy and economics at Weill Cornell Medicine. New York City. “We hope this work draws attention to possible differences across racial and ethnic groups, stimulates research into the potential mechanisms, and sparks discussion among patients, clinicians, and policymakers.” 

A second study, published in BMC Medicine, analyzed data from the electronic health records of 33,782 adults and children who received a diagnosis for long COVID between October 2021 and May 2022 at one of 34 U.S. medical centers. All patients had received the diagnosis of Post COVID-19 condition, unspecified, which was first introduced in U.S. healthcare systems in October 2021. 

https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-023-02737-6

Among the patterns recognized by researchers is that most of the patients were white, female, non-Hispanic, and likely to live in areas with low poverty and greater access to healthcare. 

Emily Pfaff, PhD., a study author and assistant professor in the Division of Endocrinology and Metabolism at the University of North Carolina, Chapel Hill, said the pattern suggests that not all patients who have long COVID are being accurately diagnosed. 

“You can see all the different ways these diagnostic codes can provide insight, but they can also skew the whole story,” Pfaff said. 

The review indicates that most patients with long COVID have mild to moderate, not severe, symptoms of acute infection. Long-term symptoms fell into common clusters – cardiopulmonary, neurological, gastrointestinal, and coexisting conditions – as well as by age, the authors advise. 

They report that children and teens were more likely to experience gastrointestinal and upper respiratory problems, including stomach aches and coughing; while adults ages 21-45 commonly experienced neurological problems, such as brain fog and fatigue. Adults ages 66 and older were more likely to have coexisting conditions, such as heart problems and diabetes, which, according to the study, could be more likely associated with age than long COVID.