Long COVID and Food Insecurity in US Adults, 2022-2023

Abstract

Importance: Long COVID (ie, post-COVID-19 condition) is a substantial public health concern, and its association with health-related social needs, such as food insecurity, remains poorly understood. Identifying modifiable risk factors like food insecurity and interventions like food assistance programs is critical for reducing the health burden of long COVID.

Objective: To investigate the association of food insecurity with long COVID and to assess the modifying factors of Supplemental Nutrition Assistance Program (SNAP) participation and employment status.

Design, setting, and participants: This retrospective, cross-sectional survey study used data from the 2022 to 2023 National Health Interview Survey. Respondents aged 18 years and older who reported prior COVID-19 infection and responded to questions on food insecurity and long COVID were included.

Exposure: Food insecurity, categorized as food secure or food insecure.

Main outcomes and measures: The primary outcome was current long COVID, defined as symptoms lasting 3 or more months after initial COVID-19 infection persisting to time of interview. The secondary outcome was long COVID recovery, indicating history of long COVID without current symptoms. Food insecurity was measured using the validated 10-item National Center for Health Statistics food insecurity scale. Odds ratios (ORs) and 95% CIs for the association of food insecurity with long COVID were calculated using simple and multiple logistic regression.

Results: The study enrolled 21 631 participants (1255 female [weighted percentage, 53%]; 5058 aged 65 years or older [weighted percentage, 16%]), including 19 824 with food security and 1807 with food insecurity. In total, 288 respondents with food insecurity (weighted percentage, 15%) reported current long COVID compared with 1547 (weighted percentage, 7%) without food insecurity. Food insecurity was positively associated with current long COVID (adjusted OR, 1.73; 95% CI, 1.39-2.15) and negatively associated with recovery among adults with prior long COVID (adjusted OR, 0.70; 95% CI, 0.54-0.92). SNAP participation (P for interaction = .04) and unemployment (P for interaction = .04) significantly modified these associations.

Conclusions and relevance: In this survey study of US adults with prior COVID-19 infection, food insecurity was associated with greater odds of long COVID and lower odds of recovery, with SNAP participation and unemployment mitigating these associations. These findings suggest that expanding SNAP eligibility, simplifying enrollment processes, and increasing awareness of food assistance programs may reduce the burden of food insecurity and long COVID and further emphasize the importance of addressing health-related social needs in chronic disease prevention and management.

Figure.. Adjusted Odds of Current Long COVID Accounting for Interactions Between Food Insecurity Status, Supplemental Nutrition Assistance Program (SNAP) Participation, and Employment Status

These multiple regression analyses included interaction terms between food insecurity and SNAP participation or employment, adjusting for age, sex, race and ethnicity, household income, region, education, employment, insurance, smoking history, weight status, number of COVID-19 vaccinations, and other chronic conditions (arthritis, asthma, cancer, chronic obstructive pulmonary disease, diabetes, and hypertension). Sample weights were applied to all analyses to account for nonresponse bias and produce nationally representative population estimates. For categorical variables, missing values were replaced with a distinct placeholder value (9999). For number of chronic conditions (ordinal variable) and COVID-19 vaccination status, missing values were dropped. aOR indicates adjusted odds ratio.