Many US Adults Affected by Long COVID, Related Activity Limitations

The 2023 National Health Interview Survey (NHIS) found that 8.4% of US adults reported ever having post–COVID-19 condition (PCC), or long COVID, with 3.6% currently affected and 2.3% experiencing activity-limiting symptoms, according to a research letter published in JAMA Network Open.1

Conducted annually by the National Center for Health Statistics (NCHS), NHIS is a nationally representative household survey of the US civilian noninstitutionalized population where one adult is randomly selected from each eligible household to answer detailed questions about their health.

In 2022, NHIS included a new question for patients with PCC, defined as the presence of symptoms lasting 3 months or longer that they did not have before having COVID-19, to determine the degree to which these long-term symptoms reduced their ability to perform daily activities vs before they had COVID-19.

The 2022 NHIS showed that 6.9% of US adults ever had PCC; nearly half (3.4% of all adults) had PCC during the interview. Using these new data, the researchers performed a cross-sectional analysis to describe the prevalence of both ever and current PCC and self-reported activity limitations due to PCC symptoms in 2023.

The 2023 National Health Interview Survey (NHIS) found that many US adults experience post-COVID-19-condition (PCC), or long COVID, with some facing activity limitations. | Image Credit: Parradee - stock.adobe.com

For the 2023 NHIS, NCHS asked each adult whether they ever had COVID-19.2 If yes, they were asked whether they had any symptoms lasting 3 months or longer that they did not experience before contracting COVID-19. Those who answered yes were then asked whether they had symptoms now and, if so, how much they reduced their ability to complete daily activities compared with before having COVID-19. The researchers defined any activity limitation, or responses of “a little” or “a lot,” as having activity-limiting PCC.1

Also, all estimates were based on self-reports, weighted to be nationally representative, and met NCHS Data Presentation Standards for Proportions. The researchers included data on race and ethnicity to estimate whether differences were observed across groups, with race based on the adult’s description of their racial and ethnic identity. Additionally, they determined urbanization levels based on data from the 2013 NCHS Urban-Rural Classification Scheme for Counties.

Among 29,522 respondents, (NHIS response rate, 47.0%), 8.4% (n = 2398; 95% CI, 8.0%-8.8%) of US adults reported they ever had PCC, 3.6% (n = 1063; 95% CI, 3.3%-3.9%) currently had PCC, and 2.3% (n = 706; 95% CI, 2.1%-2.5%) currently had activity-limiting PCC. Therefore, 64.5% of those who currently had PCC experienced symptoms that were activity-limiting. Also, the researchers observed significant differences across all 3 outcomes by sex, age, sexual orientation, family income, urbanization, and race and Hispanic origin.

In particular, the percentage of those who ever had PCC, currently had PCC, and currently had activity-limiting PCC decreased with increasing family income. In contrast, the prevalence of these 3 outcomes increased as the rurality of each respondent's place of residence increased.

Regarding race and Hispanic origin, non-Hispanic American Indian and Alaska Native adults had the highest percentage of adults ever having PCC (12.6%; 95% CI, 8.2%-18.1%), compared with non-Hispanic Asian adults (4.4%; 95% CI, 3.4%-5.7%), among whom it was least prevalent. Similarly, non-Hispanic American Indian and Alaska Native adults had the highest percentage of adults currently having PCC (6.3%; 95% CI, 3.3%-10.7%), while non-Hispanic Asian adults had the lowest percentage (1.8%; 95% CI, 1.1%-2.8%).

Lastly, non-Hispanic other and multiple races had the highest percentage of activity-limiting PCC (3.1%; 95% CI, 1.7%-5.1%), while non-Hispanic Asians had the lowest percentage (1.2%; 95% CI, 0.6%-2.0%).

The researchers acknowledged their limitations, including the reliance on self-reported data not confirmed by medical evaluation. However, they emphasized the importance of the updated national prevalence estimates of PCC and the new estimates of activity-limiting PCC provided by their study.

“This work supports the Department of Health and Human Services efforts to assess the overall disease burden of PCC across the US population,” the authors concluded.

References

1. Vahratian A, Saydah S, Bertolli J, Unger ER, Gregory CO. Prevalence of post-COVID-19 condition and activity-limiting post-COVID-19 condition among adults. JAMA Netw Open. 2024;7(12):e2451151. doi:10.1001/jamanetworkopen.2024.51151
2. National Health Interview Survey, 2023 survey description. National Center for Health Statistics. July 2024. Accessed December 16, 2024. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2023/srvydesc-508.pdf