美国RECOVER成人队列中健康的社会决定因素与长期新冠风险
Social Determinants of Health and Risk for Long COVID in the U.S. RECOVER-Adult Cohort.
作者信息
Feldman Candace H, Santacroce Leah, Bassett Ingrid V, Thaweethai Tanayott, Alicic Radica, Atchley-Challenner Rachel, Chung Alicia, Goldberg Mark P, Horowitz Carol R, Jacobson Karen B, Kelly J Daniel, Knight Stacey, Lutrick Karen, Mudumbi Praveen, Parthasarathy Sairam, Prendergast Heather, Quintana Yuri, Sharareh Nasser, Shellito Judd, Sherif Zaki A, Taylor Brittany D, Taylor Emily, Tsevat Joel, Wiley Zanthia, Williams Natasha J, Yee Lynn, Aponte-Soto Lisa, Baissary Jhony, Berry Jasmine, Charney Alexander W, Costantine Maged M, Duven Alexandria M, Erdmann Nathaniel, Ernst Kacey C, Feuerriegel Elen M, Flaherman Valerie J, Go Minjoung, Hawkins Kellie, Jacoby Vanessa, John Janice, Kelly Sara, Kindred Elijah, Laiyemo Adeyinka, Levitan Emily B, Levy Bruce D, Logue Jennifer K, Marathe Jai G, Martin Jeffrey N, McComsey Grace A, Metz Torri D, Minor Tony, Montgomery Aoyjai P, Mullington Janet M, Ofotokun Igho, Okumura Megumi J, Peluso Michael J, Pogreba-Brown Kristen, Raissy Hengameh, Rosas Johana M, Singh Upinder, VanWagoner Timothy, Clark Cheryl R, Karlson Elizabeth W
机构信息
Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts (C.H.F., E.W.K.).
Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (L.S.).
出版信息
Ann Intern Med. 2025 Jul 29. doi: 10.7326/ANNALS-24-01971.
BACKGROUND
Social determinants of health (SDoH) contribute to disparities in SARS-CoV-2 infection, but their associations with long COVID are unknown.
OBJECTIVE
To determine associations between SDoH at the time of SARS-CoV-2 infection and risk for long COVID.
DESIGN
Prospective observational cohort study.
SETTING
33 states plus Washington, DC, and Puerto Rico.
PARTICIPANTS
Adults (aged ≥18 years) enrolled in RECOVER-Adult (Researching COVID to Enhance Recovery) between October 2021 and November 2023 who were within 30 days of SARS-CoV-2 infection; completed baseline SDoH, comorbidity, and pregnancy questionnaires; and were followed prospectively.
MEASUREMENTS
Social risk factors from SDoH baseline questionnaires, ZIP code poverty and household crowding measures, and a weighted score of 11 or higher on the Long COVID Research Index 6 months after infection.
RESULTS
Among 3787 participants, 418 (11%) developed long COVID. After adjustment for demographic characteristics, pregnancy, disability, comorbidities, SARS-CoV-2 severity, and vaccinations, financial hardship (adjusted marginal risk ratio [ARR], 2.36 [95% CI, 1.97 to 2.91]), food insecurity (ARR, 2.36 [CI, 1.83 to 2.98]), less than a college education (ARR, 1.60 [CI, 1.30 to 1.97]), experiences of medical discrimination (ARR, 2.37 [CI, 1.94 to 2.83]), skipped medical care due to cost (ARR, 2.87 [CI, 2.22 to 3.70]), and lack of social support (ARR, 1.79 [CI, 1.50 to 2.17]) were associated with increased risk for long COVID. Living in ZIP codes with the highest (vs. lowest) household crowding was also associated with greater risk (ARR, 1.36 [CI, 1.05 to 1.71]).
LIMITATION
Selection bias may influence observed associations and generalizability.
CONCLUSION
Participants with social risk factors at the time of SARS-CoV-2 infection had greater risk for subsequent long COVID than those without. Future studies should determine whether social risk factor interventions mitigate long-term effects of SARS-CoV-2 infection.
PRIMARY FUNDING SOURCE
National Institutes of Health.
背景
健康的社会决定因素（SDoH）导致了严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的差异，但它们与长期新冠的关联尚不清楚。
目的
确定SARS-CoV-2感染时的SDoH与长期新冠风险之间的关联。
设计
前瞻性观察队列研究。
地点
33个州加上华盛顿特区和波多黎各。
参与者
2021年10月至2023年11月期间参加RECOVER-成人（研究新冠以促进康复）研究的成年人（年龄≥18岁），他们在SARS-CoV-2感染后30天内；完成了SDoH、合并症和妊娠基线问卷；并进行了前瞻性随访。
测量
来自SDoH基线问卷的社会风险因素、邮政编码贫困和家庭拥挤程度测量，以及感染后6个月长期新冠研究指数加权得分11或更高。
结果
在3787名参与者中，418人（11%）出现了长期新冠。在调整了人口统计学特征、妊娠、残疾、合并症、SARS-CoV-2严重程度和疫苗接种情况后，经济困难（调整后的边际风险比[ARR]，2.36[95%置信区间，1.97至2.91]）、粮食不安全（ARR，2.36[置信区间，1.83至2.98]）、未接受过大学教育（ARR，1.60[置信区间，1.30至1.97]）、医疗歧视经历（ARR，2.37[置信区间，1.94至2.83]）、因费用而跳过医疗护理（ARR，2.87[置信区间，2.22至3.70]）以及缺乏社会支持（ARR，1.79[置信区间，1.50至2.17]）与长期新冠风险增加相关。生活在家庭拥挤程度最高（与最低相比）的邮政编码地区也与更高的风险相关（ARR，1.36[置信区间，1.05至1.71]）。
局限性
选择偏倚可能影响观察到的关联和普遍性。
结论
SARS-CoV-2感染时具有社会风险因素的参与者比没有这些因素的参与者后续出现长期新冠的风险更高。未来的研究应确定社会风险因素干预措施是否能减轻SARS-CoV-2感染的长期影响。
主要资金来源
美国国立卫生研究院。
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