Study shows lasting COVID-19 symptoms lead to economic struggles for US families

In a recent study published in the journal JAMA Network Open, researchers investigated whether coronavirus disease 2019 (COVID-19) severity and symptom persistence impacted the economic conditions of United States (US) families.

Millions of US adults have experienced COVID-19-related hospitalizations and activity-limiting post-COVID-19 conditions (PCCs). Severe COVID-19 and PCCs can have significant economic consequences, with symptoms affecting daily functioning, job loss, and household finances being further stressed. Low-income families may experience more severe COVID-19 implications due to fewer resources to buffer against financial shocks. However, data on the associations between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and PCCs with family finances are limited.

Study: Association of Severe COVID-19 and Persistent COVID-19 Symptoms With Economic Hardship Among US Families. Image Credit: eldar nurkovic / Shutterstock

About the study

In the present cohort study, researchers examined associations between SARS-CoV-2-related financial difficulties and pre-COVID-19 socioeconomic conditions among US families.

The researchers analyzed the Panel Study of Income Dynamics (PSID) 2019 and 2021 national-level study data, including 6,932 active families. The PSID-2021 survey was conducted between 19 March and 31 December 2021, and the PSID-2021 Early Release file included data from 8,468 families in PSID research in 2019 and two years later. The team merged post-pandemic measures of family economic hardship and COVID-19-associated health outcomes with pre-COVID-19 sociodemographic characteristics.

The researchers defined exposure categories according to the reference individual's, partner's, or spouse's SARS-CoV-2 infection status, symptom duration, and prior history of mild-moderate or severe SARS-CoV-2 infection. Outcomes included COVID-19-related furloughed or laid-off family members, lost earnings, and financial difficulties.

The team examined three indicators of family-level financial difficulties reported by the reference individual in the PSID-2021 survey: a family member furloughed or laid off due to COVID-19, a family member lost earnings due to COVID-19, and a family member had financial struggles due to COVID-19. They obtained COVID-19 severity and symptom duration data for the reference individual, spouse, or partner.

The researchers identified closely related indicators of economic hardship collected in the PSID-2019, such as whether the reference individual, spouse, or partner missed work since they were temporarily laid off, total family labor income or any family member had a credit card or store card debt. Multinomial logistic regression modeling was performed for analysis, and adjusted odds ratios (AORs) were calculated. The PSID-2019 team analyzed sociodemographic characteristics such as the presence of children under 16, the reference individual's age, self-reported race and ethnicity, education attainment, total family income, poverty thresholds, health insurance absences in the past two years, geographic region, and nonmetropolitan residence in a nonmetropolitan area. They excluded families with missing sociodemographic or economic data and indeterminate SARS-CoV-2 exposure.


Among 6,932 families, the likelihood of facing economic hardship was higher for households managed by adults with persistent SARS-CoV-2 infection symptoms and, although to a lower extent, those headed by adults with prior severe SARS-CoV-2 infection history than those without prior COVID-19 history. Households with lower incomes in pre-pandemic times were more susceptible to job disruptions and loss of earnings related to adult household member's SARS-CoV-2 infection status. Among 6,932 families, 772 (14%) included Hispanic individuals, 2,725 (13%) included black individuals of non-Hispanic ethnicity, and 3,242 (67%) included white individuals of non-Hispanic ethnicity.

Nearly one in four [2,222 (27%)] reported household income lower than 200.0% of the United States Census Bureau cut-off for poverty. Regression modeling adjusting for pre-COVID-19 sociodemographic variables and economic hardship experiences, the likelihood of reporting COVID-19-related financial hardship was two- to four-fold higher among households managed by adult individuals with persistent SARS-CoV-2 infection symptoms [furloughed or laid-off: AOR, 2.0; lost income: AOR, 2.9; economic hardship: AOR, 3.7) and two-fold higher among those managed by adults with prior history of severe SARS-CoV-2 infection (furloughed or laid-off: AOR, 1.7; lost income: AOR, 2.0; economic hardship: AOR, 1.9) compared to those without prior COVID-19 history.

Families managed by adults with persistent SARS-CoV-2 infection symptoms were likely to report economic struggles due to COVID-19 irrespective of pre-COVID-19 socioeconomic conditions (lower-income households: AOR, 3.7; higher-income households: AOR, 3.7). Severe SARS-CoV-2 infection history was significantly related to economic hardships among lower-income households (AOR, 2.6); however, no significant associations were observed with financial struggles in higher-income families (OR, 1.6).

Overall, the study findings showed that persistent symptoms of SARS-CoV-2 infection and, although to a lower extent, prior severe SARS-CoV-2 infection history were related to an increased likelihood of COVID-19-associated financial difficulties among United States families. The financial implications of SARS-CoV-2 infection varied by socioeconomic level; households with lower household income in pre-pandemic times were more susceptible to job disruptions and income losses related to SARS-CoV-2 infections among adult family members. The findings indicate that policy actions to mitigate PCC-related household financial hardship merit continued discussion.

Journal reference:
  • Hair NL, Urban C. Association of Severe COVID-19 and Persistent COVID-19 Symptoms With Economic Hardship Among US Families. JAMA Netw Open. 2023;6(12):e2347318,  DOI:10.1001/jamanetworkopen.2023.47318,

Posted in: Men's Health News | Medical Research News | Medical Condition News | Women's Health News | Disease/Infection News

Tags: Children, Coronavirus, Coronavirus Disease COVID-19, Education, Health Insurance, Labor, Pandemic, Poverty, Research, Respiratory, SARS, SARS-CoV-2, Severe Acute Respiratory, Severe Acute Respiratory Syndrome, Syndrome

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Pooja Toshniwal Paharia

Dr. based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.

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