New evidence shows long COVID’s toll on health across all U.S. states

Lingering post-COVID symptoms are more than a nuisance, they’re independently linked to poorer physical, mental, and daily functioning across all U.S. states, highlighting urgent needs for targeted care and recovery strategies.

Study: The health-related quality of life among survivors with post-COVID conditions in the United States. Image Credit: p.ill.i / Shutterstock

In a recent study published in the journal PLoS One, a group of researchers evaluated how post-Coronavirus Disease (COVID) conditions (PCCs) affect health-related quality of life (HRQL) among COVID-19 survivors in the United States.

Background

For millions of Americans, recovering from COVID-19 is only the beginning. Nearly one in four survivors experience lingering symptoms like fatigue, brain fog, dizziness, and pain that persist for months and interfere with daily life. These lasting effects, known as PCCs, often go unnoticed as public attention shifts to infection control. While early studies have hinted at the burden PCCs place on individuals, their full impact on health-related quality of life remains poorly understood. To guide effective treatment and policy, there is an urgent need to identify who is most at risk and how best to support them.

About the study

Researchers analyzed data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS), a national survey led by the Centers for Disease Control and Prevention (CDC), which gathers health information via telephone from United States (U.S.) adults. They focused on individuals who had previously tested positive for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), excluding those with only at-home diagnoses or incomplete responses. Participants were divided into two groups: those reporting PCCs, defined as symptoms persisting at least three months after acute COVID-19, and those without.

The primary outcome was health-related quality of life (HRQL), assessed through four self-reported measures: general health, mental health, physical health, and daily functional ability. Sociodemographic characteristics, comorbidities, and behavioral habits (such as physical activity, smoking, and sleep patterns) were also recorded. Advanced statistical techniques, including multivariate logistic regression and data imputation via random forest modeling, were used to adjust for missing data and confounding factors. Survey weights and design adjustments were applied to reflect the U.S. adult population. The association between PCCs and unfavorable self-reported general health (SRGH) was analyzed after accounting for all relevant variables.

The researchers noted that the BRFSS relies on self-reported data, which may be subject to recall bias or reporting inaccuracies. Additionally, some variables that could influence PCC risk and outcomes, such as vaccination status, medications, or the timing and severity of initial COVID-19 infection, were not available in the dataset. Institutionalized individuals were not included in the survey, and the HRQL questions were not based on a standardized questionnaire. These limitations should be considered when interpreting the study’s results.

Study results

The study included 108,237 adults with confirmed SARS-CoV-2 infection, representing over 70 million Americans. Among them, 22.7% experienced PCCs. Individuals with PCCs were more likely to be female, middle-aged, obese, physically inactive, and report lower income and poor sleep habits.

Overall, 25.7% of those with PCCs rated their general health as “fair” or “poor,” compared to 15.5% of those without PCCs. These individuals also reported more days of poor mental and physical health, as well as greater disruption in daily activities. In adjusted regression models, having PCCs was independently associated with a 39% higher likelihood of unfavorable general health (adjusted odds ratio [aOR]: 1.39, 95% confidence interval [CI]: 1.28–1.52, p < 0.001).

When examining symptoms, dizziness on standing (38%), mood disorders (36.3%), and musculoskeletal pain (34.1%) were most strongly linked with poor health ratings. Conversely, symptoms like loss of taste or smell were less likely to impair overall well-being. Notably, the association between PCCs and lower HRQL remained significant across all age groups and states, suggesting a widespread and systemic burden.

Among those with PCCs, further analysis revealed that certain factors increased the risk of poor general health. These included being in late middle age (45–64 years old; aOR = 1.47), having obesity (aOR = 1.27), being physically inactive (aOR = 1.94), or sleeping too little or too much (aOR = 1.55 and 2.15, respectively). Chronic conditions such as diabetes (aOR = 2.29), heart disease (aOR = 2.01), and pulmonary diseases (aOR = 1.98) also significantly raised the odds of unfavorable health. Socioeconomic factors, including lower education and income, single marital status, and Hispanic ethnicity, were independently associated with worse outcomes.

Interestingly, while women with PCCs were more likely to report poor health, gender was not a significant factor after statistical adjustment. State-level analysis showed that regions like West Virginia, Kentucky, and Oregon reported the highest rates of impaired general health, underscoring geographic disparities in long COVID impact.

The study also emphasized that while PCCs were more prevalent among younger adults, the association between PCCs and impaired quality of life was particularly strong among those in their late middle age (45–64 years old). This highlights the complex relationship between age, risk of PCCs, and their impact on daily functioning.

Conclusions

To summarize, post-COVID conditions are linked to significantly reduced health-related quality of life across the U.S., affecting physical, mental, and daily functioning. Individuals with chronic illnesses, obesity, lower socioeconomic status, or unhealthy lifestyle habits are particularly vulnerable. These findings emphasize the need for multidisciplinary care models, long-term monitoring, and targeted rehabilitation strategies for COVID-19 survivors. The authors also call for further research to better understand and address the limitations of current data sources and to optimize support for those living with PCCs. As the pandemic’s acute phase recedes, addressing the hidden burden of PCCs becomes essential for national health planning.