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Multicenter Study
. 2025 Aug 1;8(8):e2526310.
doi: 10.1001/jamanetworkopen.2025.26310.

Work Impairment and Financial Outcomes Among Adults With vs Without Long COVID

Michael Gottlieb  1 , Ji Chen  2   3 , Huihui Yu  2   3 , Michelle Santangelo  1 , Erica S Spatz  2   3   4 , Nicole L Gentile  5   6   7 , Rachel E Geyer  5 , Caitlin Malicki  8 , Kristyn Gatling  9 , Kelli N O'Laughlin  10   11 , Kari A Stephens  5   12 , Joann G Elmore  13   14 , Lauren E Wisk  13 , Michelle L'Hommedieu  13 , Robert Rodriguez  15 , Juan Carlos C Montoy  15 , Ralph C Wang  15 , Kristin L Rising  16   17 , Efrat Kean  16   17 , Jonathan W Dyal  18 , Mandy J Hill  19 , Arjun K Venkatesh  8   20 , Robert A Weinstein  21   22   23 ; INSPIRE Group
Collaborators, Affiliations
Multicenter Study

Work Impairment and Financial Outcomes Among Adults With vs Without Long COVID

Michael Gottlieb et al. JAMA Netw Open. .

Abstract

Importance: While much of the focus on long COVID (LC; defined as developing new, persistent symptoms lasting 3 months or longer after SARS-CoV-2 infection) has been on health status and quality of life, the impact on individual work productivity and financial distress are less well established.

Objectives: To assess differences in work and financial outcomes among individuals with current, resolved, and no LC up to 3 years after initial infection.

Design, setting, and participants: This prospective, multisite, longitudinal cohort study enrolled adult participants (age ≥18 years) with at least 1 reported SARS-CoV-2 infection from December 7, 2020, to August 29, 2022. Follow-up electronic surveys were collected through April 2, 2024. Data were analyzed from January 20 to February 4, 2025.

Exposure: Self-reported resolved or current LC and vaccination status.

Main outcomes and measures: Financial toxicity was measured using Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (FACIT-COST), and work impact was measured using the Work Productivity & Activity Impairment questionnaire (version 2.0).

Results: Of 3663 participants (mean [SD] age, 40.2 [14.2] years; 2429 [66.3%] female), 994 (27.1%) reported current LC, 2604 (71.1%) never had LC, and 65 (1.8%) had resolved LC. Participants with current LC reported more overall work impairment due to health (mean [SD], 17.7% [25.3%] of total hours worked per week) compared with those who never had LC (mean [SD], 3.2% [11.8%] of total hours) and resolved LC (mean [SD], 5.6% [12.2%] of total hours), with significantly increased odds of any work impairment compared with those who never had LC (adjusted odds ratio [aOR], 7.24; 95% CI, 5.68-9.21). The current LC group had increased odds of missing work due to their health (aOR, 2.62; 95% CI, 1.93-3.57) and of experiencing work impairment (aOR, 11.82; 95% CI, 8.90-15.70) compared with the group who never had LC. Individuals with current LC had increased odds of having moderate to high FACIT-COST scores compared with those who never had LC (aOR, 5.20; 95% CI, 3.92-6.89) and compared with those with resolved LC (aOR, 3.16; 95% CI, 1.19-8.41). Participants who were vaccinated had lower overall work impairment (aOR, 0.71; 95% CI, 0.55-0.92), impairment while working (aOR, 0.66; 95% CI, 0.50-0.87), impairment of nonwork activities (aOR, 0.74; 95% CI, 0.57-0.96), and financial toxicity (least-squares mean difference, 1.07; 95% CI, 0.19-1.95) compared with those who were not vaccinated.

Conclusions and relevance: In this prospective cohort study of adults with SARS-CoV-2 infection, participants with current self-reported LC reported worse work impairment, missed work, and financial distress compared with those who never had LC, while vaccination was associated with improved work outcomes and less financial distress even among individuals with LC. These data underscore the need for postpandemic assistance programs, as well as vaccination to decrease societal harms.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Gentile reported grants from the National Center for Complementary and Integrative Health (NCCIH), National Institute on Aging, and Agency for Healthcare Research and Quality (AHRQ) outside the submitted work. Dr Geyer reported grants from AHRQ and NCCIH outside the submitted work. Dr Elmore reported serving as Editor-in-Chief of Primary Care for UpToDate. Dr Wisk reported grants from National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and National Institute of Mental Health (NIMH) outside the submitted work. Dr Montoy reported grants from Substance Abuse and Mental Health Services Administration (SAMHSA), the US Food and Drug Administration (FDA), and grants from National Institute of Neurological Disorders and Stroke (NIHDS) during the conduct of the study. Dr Rising reported grants from the Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH) outside the submitted work. Dr Venkatesh reported grants from SAEM Foundation outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Participant Enrollment Flowchart
INSPIRE indicates Innovative Support for Patients with SARS-CoV-2 Infections Registry.
Figure 2.
Figure 2.. Differences in Work Productivity Among Individuals With Current, Resolved, and Never Long COVID (LC)
OR indicates odds ratio, WPAI, Work Productivity and Activity Impairment Questionnaire.
Figure 3.
Figure 3.. Difference in Financial Toxicity Among Individuals With Current, Resolved, and Never Long COVID (LC)
LS indicates least-squares; OR, odds ratio.
See this image and copyright information in PMC

References

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