Identifying Potential Vulnerability to Long COVID Through Global-to-Local Inequalities in Years Lived With Disability Attributed to C19, 2025, Shan

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https://onlinelibrary.wiley.com/doi/10.1002/mdr2.70023

Identifying Potential Vulnerability to Long COVID Through Global-to-Local Inequalities in Years Lived With Disability Attributed to COVID-19, 2020–2021, Across 920 Locations​

Dan Shan, Wenyi Jin, Fei Li, Chengliang Yang, You Zeng, Ruiling Xie, Qingjia Zeng, Yi Chen, Haowei Wang, Christine Linehan, Claire Chenwen Zhong, Qiaoyu Shao, Xiaozhu Liu … See all authors
First published: 03 August 2025

https://doi.org/10.1002/mdr2.70023
Funding: This work was supported by the Bill & Melinda Gates Foundation and the Canadian Institutes of Health Research (Grant 177747). The funders of this study had no role in study design, data collection, data analysis, data interpretation, or the writing of the report.

Dan Shan, Wenyi Jin, Fei Li, and Chengliang Yang are joint first authors.

Salman Rawaf and Azeem Majeed are joint senior authors.

Queran Lin, Ting Luo, Scott J. Tebbutt, and Dan Shan are joint corresponding authors.

ABSTRACT​

The COVID-19 pandemic has reshaped global health; however, the long-term burden of long COVID remains poorly understood, especially in low- and middle-income countries (LMICs), where limited surveillance and data gaps may obscure a substantial and sustained impact.

Using the Global Burden of Disease (GBD) 2021 framework, we previously assessed the direct COVID-19 burden—including incidence, prevalence, mortality, and disability-adjusted life-years (DALYs)—across 920 locations during 2020–2021.

In this study, we focus on years lived with disability (YLDs), particularly in 2021, as a potential early indicator to identify locations and populations that may be at higher risk of long COVID burden in subsequent years (e.g., 2022–2023).

We also examine patterns of inequality to highlight vulnerable groups.

Our findings are consistent with multiple large-scale studies on long COVID and suggest that YLDs may serve as a useful early proxy for ongoing burden. Importantly, we identify notably higher age-standardized YLD rates in LMICs—especially in Sub-Saharan Africa and in parts of South Asia and Eastern Europe.

These areas, previously underexplored in long COVID research, might be particularly susceptible to its effects. Among the top 10 countries with the highest age-standardized YLD rates in 2021, 80% fell within the low, low-middle, and middle Socio-demographic Index (SDI) categories.

These high age-standardized YLD rates may point to systemic vulnerabilities and entrenched structural health disparities, indicating a potential for considerable and enduring long COVID burden that could persist to the present day in the absence of targeted interventions.

Furthermore, our inequality analysis underscores that while both advantaged and disadvantaged groups in LMICs require attention, the most disadvantaged groups warrant special focus due to their more severe resource constraints and restricted capacity for resilience-building.

Overall, this study supports calls for stronger surveillance, expanded access to rehabilitation, and better integration of long COVID care into universal health coverage.

Continued GBD updates will be essential for monitoring trends and guiding responsive public health strategies.

 

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Global analysis reveals overlooked hotspots at risk for long COVID due to early disability burdens

A new global study has identified striking inequalities in disability caused by COVID-19 during 2020–2021, offering an early warning signal for the ongoing risk of long COVID in the years that followed — and even today. By examining across 920 locations worldwide, researchers found that low- and...

www.eurekalert.org

News Release 26-Aug-2025

Global analysis reveals overlooked hotspots at risk for long COVID due to early disability burdens​

Peer-Reviewed Publication
FAR Publishing Limited



Credit: Dan Shan

An international team of researchers has conducted the most comprehensive global-to-local analysis to date on long COVID risk, using disability data from the height of the pandemic to identify vulnerable populations. Drawing on the Global Burden of Disease (GBD) 2021 framework, the study examined years lived with disability (YLDs) caused by COVID-19 across 920 locations during 2020 and 2021. The results reveal that YLDs may serve as an early indicator of long COVID risk—particularly in areas where post-COVID conditions remain underreported.

“Disability-related data may serve as an early warning indicator for long COVID,” said Dan Shan, co-first author of the study. “We found that many communities, especially in low-resource settings, were already experiencing a disproportionately high burden of prolonged symptoms. Without intervention, this might translate into years of long COVID consequences that go largely untracked.”

The study uncovered alarming disparities. In 2021, eight of the top ten countries with the highest age-standardized YLD rates were low-, lower-middle-, or middle-income nations, such as Mozambique, Malawi, Ethiopia, and Iraq. These locations often lack robust health systems, making it harder to diagnose, report, and manage post-acute COVID conditions. In addition, women aged 20 and above were found to bear a significantly higher burden than men, consistent with trends reported in other long COVID research.

While wealthier countries often had lower overall YLD rates, the researchers found large inequalities within them. In the United States, for example, potential long COVID risk varied widely across states, with rural and underserved areas showing higher YLD rates. This pattern suggests that national averages could obscure important local vulnerabilities—something the authors say should be addressed in future public health strategies.

“Even within high-income nations, we saw dramatic differences between communities,” said Shan. “The effects of long COVID are not equally distributed, and without granular data, certain subgroups may be overlooked in policy decisions.”

The researchers call for urgent expansion of long COVID care, especially in lower-resource settings, and for the integration of disability data into early warning systems. They also urge global health agencies to prioritize vulnerable groups for rehabilitation services, research funding, and surveillance infrastructure. “Ignoring these warning signs risks deepening global health inequalities for years to come,” Shan suggested.

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Journal​

Med Research

DOI​

10.1002/mdr2.70023