Neighborhood Deprivation and Symptom Burden Among Older Adults After Hospitalization for COVID-19

Abstract

Persistent symptoms following COVID-19 disproportionately affect older adults and may be exacerbated by neighborhood socioeconomic deprivation. We evaluated the association between neighborhood deprivation and symptom burden after COVID-19 hospitalization among 298 older adults from five Connecticut hospitals (June 2020-June 2021). Symptom burden was measured using the Edmonton Symptom Assessment System at baseline and 1, 3, and 6 months post-discharge, while neighborhood deprivation was assessed with the Area Deprivation Index. Using Bayesian linear mixed models adjusted for demographic and clinical factors, we found that residing in high-deprivation neighborhoods (ADI > 9/10; n = 28) was associated with higher symptom burden over the 6-month follow-up period. Adjusted analyses estimated a 2.2-point greater mean symptom burden (95% CI: 0.1-4.2). These findings suggest that neighborhood socioeconomic factors may significantly contribute to the persistence of COVID-19 symptoms in older adults, underscoring the need for targeted post-discharge care strategies.

Keywords: COVID-19; deprivation; neighborhoods; older adults; patient-centered outcomes.

Figure 1.

Symptom Burden Over 6 Months by Neighborhood Deprivation Levels Among Older Survivors of a COVID Hospitalization. The Unadjusted Mean Edmonton Symptom Assessment Scale Score and Standard Error at Baseline (In-Hospital), 1 Month, 3 Months, and 6 Months Are Shown in the Figure, Stratified by Those Living in Severely Deprived Neighborhoods (Area Deprivation Index [ADI] ≥90th Percentile; Orange Line) and Those Living in Less Deprived Neighborhoods (ADI <90th Percentile; Dashed Blue Line). Data Were Missing for 9/112 (8.0%) Assessments for the Severely Deprived Neighborhood Group, and for 155/1080 (14.3%) of the Less Deprived Neighborhood Group