Are COVID-19 outcomes, including severe COVID-19 and persistent symptoms, associated with economic hardship among US families?

By Vijay Kumar MalesuDec 13 2023Reviewed by Danielle Ellis, B.Sc.

In a recent study published in JAMA Network Open, a group of researchers investigated the relationship between coronavirus disease- 2019 (COVID-19) health outcomes, economic hardship during the pandemic, and pre-pandemic socioeconomic status in United States (US) families.

Background

The COVID-19 pandemic has led to over 5.9 million hospital admissions in the US, with an estimated 3 to 5 million adults living with debilitating post-COVID-19 conditions (PCCs). Approximately 15% of US adults have experienced PCCs at some point. These health issues have significant economic repercussions, affecting employment and household finances. Individuals with severe COVID-19 or PCCs often face reduced work capacity and increased unemployment. Hospitalizations related to COVID-19 are also linked to job loss.

The financial strain is exacerbated by medical expenses and lost caregiver productivity. Low-income families, more likely to experience severe COVID-19 impacts, face heightened financial challenges. Further research is needed to fully understand and address the extensive and nuanced economic impacts of COVID-19, especially on families with lower incomes who are disproportionately affected by both health and financial consequences.

About the study

Adhering to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cohort studies, the present research utilized data from the Panel Study of Income Dynamics (PSID), a comprehensive, longitudinal study of US families. This study specifically employed data from the PSID surveys conducted in 2019 and 2021, which included new questions to assess the impact of the COVID-19 pandemic on families' health and finances.

The 2021 PSID survey, conducted between March and December, gathered information on COVID-19-related health outcomes and financial difficulties from a balanced panel of families active in both the 2019 and 2021 surveys. The research team focused on merging post-pandemic economic hardship and health outcomes from the 2021 survey with pre-pandemic sociodemographic data from 2019. Families lacking complete sociodemographic or economic data, or those with indeterminate COVID-19 exposure, were excluded, resulting in a cohort of 6932 families.

The study examined three primary indicators of economic hardship: layoffs or furloughs, loss of earnings, and financial difficulties due to the pandemic. It also categorized families based on COVID-19 exposure, distinguishing between persistent symptoms, severe cases, and moderate to mild or asymptomatic cases. The research analyzed a range of sociodemographic variables from the 2019 PSID survey, including family composition, race and ethnicity, education level, income relative to poverty thresholds, health insurance status, geographic region, and residence in non-metropolitan areas.

Statistical analysis involved multinomial logistic regression to assess correlations between sociodemographic characteristics, baseline economic hardship, and COVID-19 exposure. Logistic regression models were then used to explore the associations between COVID-19 exposure and pandemic-related economic hardships. The analyses were stratified by pre-pandemic family income to examine if the impact varied across different socioeconomic statuses. Stata software was used for all analyses, applying family weights provided by the PSID, and results were considered significant if the 95% confidence intervals did not include 1.

Study results 

In the present study, 15.4% of the families were led by an adult with a COVID-19 diagnosis. Among these, 4.4% had persistent COVID-19, 3.1% had severe COVID-19, and 7.9% had moderate, mild, or asymptomatic COVID-19. Notably, around one in four households with a prior COVID-19 diagnosis reported symptoms indicative of PCCs. The remaining 84.6% of families in the sample had no history of COVID-19 illness.

The sample was ethnically diverse, with 13.5% Hispanic, 66.8% non-Hispanic White families, and 13.1% non-Hispanic Black. Approximately 25% of these families had at least one child under 16 years, and nearly 75% were headed by an adult with some college education, including 36.8% who were college graduates. About one in four families reported income below 200% of the poverty threshold.

It was noted that it had very high odds of economic problems in families whose heads are an adult with persistent COVID-19 symptoms in comparison to other families during the pandemic. However, families with a long background of severe COVID-19 were 1.7 to 2.0 times more likely than non-COVID families to experience similar issues. Nonetheless, moderate levels of mild or asymptomatic COVID-19 were, in most cases, associated with economic hardship at the non-statistical level.

Sensitivity analyses yielded similar results, confirming these findings. Among families with lower income, the odds of a resident family member being laid off or experiencing financial difficulties were not significantly different for those with persistent COVID-19 symptoms compared to those without COVID-19. However, for families with higher incomes, the likelihood of economic hardships was significantly higher in those headed by adults with persistent COVID-19 symptoms.

Additionally, the study found no significant associations between previous severe COVID-19 and economic hardship in families with higher incomes. Similarly, there were no significant associations between moderate, mild, or asymptomatic COVID-19 and economic hardship in these families. This comprehensive analysis sheds light on the varying economic impacts of COVID-19 based on the severity of the illness and the pre-pandemic socioeconomic status of families, highlighting the multifaceted nature of the pandemic's repercussions on household finances.