The Impact of Socioeconomic Disparities on Pulmonary Rehabilitation Participation and Morbidity in the Long COVID Population

Background: COVID-19 infection predominantly affects the respiratory system. Long COVID refers to individuals experiencing long-term effects following COVID-19 infection, often leading to various clinical manifestations and lasting morbidity. Pulmonary rehabilitation (PR) is well-established, but under-utilized intervention known to improve lung function, exercise capacity, and quality of life in other pulmonary disease populations. Social determinants of health, including socioeconomic status (SES), neighborhood environment, housing conditions, environmental exposures, and access to healthcare, have been shown to affect outcomes in various pulmonary disease populations across different racial and ethnic groups. This study aimed to investigate the impact of SES on PR participation and morbidity among individuals with Long COVID. We hypothesized that individuals with Long COVID who have SES disparities, such as financial, food, transportation or housing insecurities are less likely to participate in PR and more likely to experience higher odds of morbidity compared to those without such disparities. Methods: This study utilized data from the TriNetX Global Collaborative Network and included adults aged 18 years and older, with an ICD-10 diagnosis of Long COVID (n = 67,019). Outcome variables included PR participation and morbidity, based on hospital visits, emergency room visits, and inpatient hospital stays. The primary independent variables were Long COVID diagnosis and SES disparities. Covariates were socio-demographics, comorbid conditions, and medication usage. Cohorts were defined based on the presence or absence of any SES disparity among Long COVID subjects. Propensity score matching was applied to all covariates to create balanced cohorts. Measures of association, Kaplan-Meier survival analysis, and frequency analyses were used to assess PR participation and morbidity outcomes. Results: After propensity score matching, each cohort consisted of 4,388 subjects. Long COVID patients with SES disparities had 2.3%, 29.4%, and 38.7% higher risks of hospital visits, emergency room visits, and inpatient hospital stays compared to those without disparities, respectively. Conclusions: PR is underutilized among Long COVID patients regardless of socioeconomic status. Additionally, socioeconomic disparities are associated with increased morbidity in Long COVID patients, highlighting the need for targeted interventions to address these disparities.