Abstract
Introduction: There are concerns of postacute sequelae of COVID-19, but the impact of long COVID on the US workforce is unclear.
Methods: We analyzed the nationally representative 2022 Medical Expenditure Panel Survey (MEPS). Adult (aged 18 or above) full time workers were classified as those who had never had COVID-19, those who had COVID-19 without long COVID, and those who had long COVID. The number of days of work missed due to illness in 2022 was assessed in unadjusted negative binomial regressions and those adjusted for paid sick leave, age, sex, race and comorbidities.
Results: Among 125,151,402 (weighted) adults, 42.9% never had COVID-19, 49.6% had COVID-19 without long COVID, and 7.5% had long COVID. Patients with long COVID missed more than 8 days of work in a year which was 171% higher than patients without COVID-19% and 62% higher than those who had COVID-19 without long COVID. After adjusting for potential confounding variables, patients who had COVID-19 without long COVID had a greater rate of missing work (IRR 1.75; 95% CI 1.51, 2.04) compared with those who did not have COVID-19. Long COVID patients had an even higher rate of missing work (IRR 2.21; 95% CI 1.79, 2.73) compared with those who did not have COVID-19.
Discussion: An additional outcome for patients with long COVID is an impact on the workforce and significantly more missed workdays.
Introduction
Long COVID is an often-debilitating illness that can occur following infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).1 The estimated prevalence of long COVID in the US adult population is 7.5%.2 26.4% of adults with long COVID report significant activity limitations.2 Despite its high prevalence and health impacts, the associated effects of long COVID on the US workforce is unclear.3 We are not aware of any previous studies that have examined whether individuals with long COVID miss more workdays than individuals who have had COVID-19 without long COVID, and individuals who have never had COVID-19. Consequently, this study addresses a very important research gap regarding our knowledge about long COVID and its impact on the US workforce. This study aimed to determine the relationship between long COVID and days of work missed due to illness or injury by US adults.
Methods
We analyzed the nationally representative 2022 Medical Expenditure Panel Survey (MEPS). Adult (≥18 years) full time workers according to the US Bureau of Labor Statistics were classified as a) never had COVID-19, b) had COVID-19 without long COVID, and c) had long COVID, defined as ever having had COVID-19 symptoms lasting for 3 months or more. This definition is analogous with those provided by the Centers for Disease Control and Prevention and the National Academies of Sciences, Engineering, and Medicine at the time of analysis.4,5 Unadjusted mean number of days of work missed due to illness/injury in 2022 among the 3 groups was assessed using one-way ANOVA. Negative binomial regression, both unadjusted and adjusted for paid sick leave, age, sex, race, education, census region, marital status, having a usual care provider, COVID-19 vaccination, cigarette smoking, and common comorbidities associated with poorer prognoses in COVID-19 infection (hypertension, diabetes, and pulmonary conditions)6,7 (assessed Incidence Rate Ratios (IRRs) of days of work missed. As nonhuman subjects research, the study was exempt from IRB review by the University of Florida.
Results
Demographic characteristics of the study population overall and stratified by COVID-19 and long COVID history are reported in Table 1. Among 125,151,402 (weighted) adults, 53.7 million (42.9%) never had COVID-19, 62.1 million (49.6%) had COVID-19 without long COVID, and 9.4 million (7.5%) had long COVID. Compared with the overall study population, individuals with long COVID were significantly more likely to be aged 45 years and over, female, non-Hispanic white, educated at the high-school diploma level or lower, living in the Northeast or the Midwest US, married, without paid sick leave, a current cigarette smoker, diagnosed with a pulmonary condition or hypertension, and to have a usual care provider.
Characteristics of the Population Overall and Stratified by COVID-19 and Long COVID History
Adults with long COVID missed, on average, more than 8 days of work in a year, which was 171% more than patients without COVID-19 and 62% more than those who had COVID-19 without long COVID (Table 2). The results from the unadjusted negative binomial regression showed that, compared with adults who never had COVID-19, the rate at which workdays were missed was higher in adults who had COVID-19 without long COVID (IRR 1.67, 95% CI 1.44, 1.93), and even higher in those with long COVID (IRR 2.70, 95% CI 2.20, 3.31). In the adjusted model, compared with adults who never had COVID-19, the rate at which workdays were missed was again higher in both adults who had COVID-19 without long COVID (IRR 1.75; 95% CI 1.51, 2.04), and in adults who had long COVID (IRR 2.21; 95% CI 1.79, 2.73).
Number of Days of Work Missed Due to Illness or Injury in 2022, Stratified by COVID-19 and Long COVID History
Discussion
In this nationally representative survey, US adults with long COVID missed significantly more workdays in 2022 than both adults who never had COVID-19 and those who had COVID-19 without long COVID, even when controlling for paid sick leave. These findings dovetail with other evidence that long COVID, in addition to outcomes like death and hospitalization, significantly impacts the daily lives of sufferers, which carries over to the workforce and productivity.2,8,9 These results suggest that developing better prevention, whether through new strategies or existing strategies such as vaccination, should be a priority.
A strength of this study was the nationally representative sampling frame. The weighted 7.5% prevalence of long COVID in the overall study population is closely aligned with the estimated prevalence in other nationally representative surveys, supporting the study’s external validity.2,4 A limitation was that COVID-19 and long COVID were defined by subject response rather than test results and clinician diagnosis, which could have affected the accuracy of all groups. However, long COVID is defined by patient self-report of symptoms,4,5 thus this method follows general diagnostic guidelines.
Long COVID is associated with a significant impact on work productivity from days missed by workers due to illness or injury. Prevention of long COVID should become a health care priority.
Notes
This article was externally peer reviewed.
Funding: None.
Conflict of interest: None. The findings and conclusions of this report are those of the authors and do not represent the official policy of the American Medical Association.
To see this article online, please go to: http://jabfm.org/content/38/3/551.full.
- Received for publication October 8, 2024.
- Revision received December 5, 2024.
- Accepted for publication December 11, 2024.
