Predictors of Post-Acute Sequelae of COVID-19 in a Diverse Urban Population

Background

Post-acute sequelae of SARS-CoV-2 infection (PASC) are ongoing, relapsing, or new symptoms present at least 3 months after infection. Predictors of PASC, particularly across diverse racial and ethnic groups, remain unclear.

Objectives

Assess the prevalence of PASC 1 year after infection, examining differences in PASC prevalence by the social construct of race.

Design

Retrospective observational cohort study.

Participants

In total, 863 adults aged 18 years or older, who were assessed for COVID-19 at two hospitals in New York City during the first two waves of the pandemic (March to July 2020 and January to March 2021).

Main Measures

Prevalence of self-reported PASC, including its respiratory and neurological phenotypes. Data were gathered via telephone surveys conducted 11–15 months following diagnosis. Logistic regression models were used to identify predictors of PASC.

Key Results

In total, 54.1% of those diagnosed with COVID-19 reported PASC symptoms 1 year after infection. Racial and ethnic disparities in the prevalence of PASC varied by PASC phenotype and by the time of initial diagnosis (Wave 1 versus Wave 2). Asian adults had significantly lower odds of reporting any PASC compared to White adults (AOR = 0.55, p=0.02), particularly for neurological symptoms (AOR = 0.5, p=0.01). Black adults had significantly higher odds of reporting respiratory PASC (AOR = 2.67, p<0.001) and lower odds of neurological PASC (AOR = 0.54, p=0.02). Females had higher odds of respiratory (AOR = 1.45, p=0.04) and neurological PASC (AOR = 1.45, p=0.02). Loneliness was consistently associated with higher odds of all PASC categories.

Conclusions

This study reveals a high prevalence of PASC 1 year post-infection, with notable racial and ethnic disparities. The results underscore the need for long-term monitoring of those infected with COVID-19 during the initial waves, with a focus on identifying and addressing yet unmeasured social determinants of health that contribute to these disparities.