Social Determinants of Health and Pediatric Long COVID in the US, 2026, Rhee et al.

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https://jamanetwork.com/journals/jamapediatrics/fullarticle/2843098

Key Points​

Question What is the association between adverse social determinants of health and long COVID in school-aged children and adolescents?

Findings In this cross-sectional analysis of a meta-cohort study including 4584 US children and adolescents, households with greater economic instability and poorer social or community context (eg, low social support and high levels of discrimination) experienced significantly higher odds of pediatric long COVID.
However, those experiencing food security, despite other economic challenges, did not have higher odds of long COVID; results were similar across age groups.

Meaning The findings of an association between adverse social determinants of health and greater likelihood of pediatric long COVID suggest that addressing adverse social drivers may mitigate future disease risk.

Abstract​

Importance Millions of children worldwide are experiencing prolonged symptoms after SARS-CoV-2 infection, yet social risk factors for developing long COVID are largely unknown.
As child health is influenced by the environment in which they live and interact, adverse social determinants of health (SDOH) may contribute to the development of pediatric long COVID.

Objective To identify whether adverse SDOH are associated with increased odds of long COVID in school-aged children and adolescents in the US.

Design, Setting, and Participants This cross-sectional analysis of a multicenter, longitudinal, meta-cohort study encompassed 52 sites (health care and community settings) across the US. School-aged children (6-11 years; n = 903) and adolescents (12-17 years; n = 3681) with SARS-CoV-2 infection history were included.
Those with an unknown date of first infection, history of multisystem inflammatory syndrome in children, or symptom surveys with less than 50% of questions completed were excluded.
Participants were recruited via health care systems, long COVID clinics, fliers, websites, social media campaigns, radio, health fairs, community-based organizations, community health workers, and existing research cohorts from March 2022 to August 2024, and surveys were completed by caregivers between March 2022 and August 2024.

Exposure Twenty-four individual social determinant of health factors were grouped into 5 Healthy People 2030 domains: economic stability, social and community context, caregiver education access and quality, neighborhood and built environment, and health care access and quality.
Latent classes were created within each domain and used in regression models.

Main Outcomes and Measures Presence of long COVID using caregiver-reported, symptom-based, age-specific research indices.

Results The mean (SD) age among 4584 individuals included in this study was 14 (3) years, and 2330 (51%) of participants were male.
The number of latent classes varied by domain; the reference group was the class with the least adversity.
In unadjusted analyses, most classes in each domain were associated with higher odds of long COVID.
After adjusting for many factors, including age group, sex, timing of infection, referral source, and other social determinant of health domains, economic instability characterized by difficulty covering expenses, poverty, receipt of government assistance, and food insecurity were associated with an increased risk of having long COVID (class 2 adjusted odds ratio [aOR], 1.57; 95% CI, 1.18-2.09; class 4 aOR, 2.39; 95% CI, 1.73-3.30); economic instability without food insecurity (class 3) was not (aOR, 0.93; 95% CI, 0.70-1.23).
Poorer social and community context (eg, high levels of discrimination and low social support) was also associated with long COVID (aOR, 2.17; 95% CI, 1.77-2.66). Sensitivity analyses stratified by age group and adjusted for race and ethnicity did not alter or attenuate these results.

Conclusions and Relevance In this study, economic instability that included food insecurity and poor social and community context were associated with greater odds of pediatric long COVID.
Those with food security, despite experiencing other economic challenges, did not have greater odds of long COVID.
Further study is needed to determine if addressing SDOH factors can decrease the rate of pediatric long COVID.

 

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Food insecurity and adverse social conditions tied to increased risk of long COVID in children

New research led by Mass General Brigham investigators suggests that long COVID is more prevalent in school-aged children and adolescents who experience economic instability and adverse social conditions. The multi-center, observational study found that the risk of long COVID was significantly...

www.eurekalert.org

News Release 5-Jan-2026

Food insecurity and adverse social conditions tied to increased risk of long COVID in children​

Results identified social risk factors associated with greater odds of prolonged SARS-CoV-2 symptoms

Peer-Reviewed Publication
Brigham and Women's Hospital

• Mass General Brigham researchers looked at data on 4,584 participants across 52 U.S. sites from the federally funded RECOVER-Pediatrics study
• Results identified social risk factors associated with greater odds of prolonged SARS-CoV-2 symptoms

New research led by Mass General Brigham investigators suggests that long COVID is more prevalent in school-aged children and adolescents who experience economic instability and adverse social conditions. The multi-center, observational study found that the risk of long COVID was significantly higher in households that faced food insecurity and challenges such as low social support and high levels of discrimination. Results are published in JAMA Pediatrics.

“Long COVID in children is especially concerning because of the potential for long-term health effects that could persist into adulthood,” said co-first author Tanayott Thaweethai, PhD, of Massachusetts General Hospital Biostatistics. "Public health interventions that target social risk factors—such as food insecurity and lack of social support—are critical to reduce the burden of long COVID and safeguard the overall health of children as they continue to acquire COVID-19."

Social determinants of health (SDOH) are non-medical factors that stem from the environment in which a person lives and interacts with others. Prior research has either been conducted in adults or focused largely on how adverse SDOH can impact the risk of getting sick with COVID-19. However, experts estimate that millions of children around the world experience prolonged COVID symptoms, highlighting the need to examine the link between adverse SDOH and pediatric long COVID.

Seeking answers, the research team analyzed data from a subset of the federally funded RECOVER (Researching COVID to Enhance Recovery) Initiative. The cohort included 903 school-aged children and 3,681 adolescents with history of SARS-CoV-2 infection, who were recruited at 52 sites across the U.S. The study examined associations between long COVID and 24 social risk factors, grouped into five main domains: economic stability (e.g., food insecurity, poverty), social and community context (e.g., caregiver marital status, discrimination), caregiver education access and quality, neighborhood and built environment, and healthcare access and quality.

The researchers found that economic instability and poor social context, like difficulty covering expenses or facing discrimination, mattered most and had the greatest impact on risk of long COVID. By contrast, food security was protective, even for families with other economic challenges.

The authors speculate that healthy diets may decrease inflammation and thus protect against risk of long COVID. Further research is needed to investigate whether addressing these adverse social factors can mitigate future disease risk.

Authorship: In addition to Thaweethai, Mass General Brigham authors include Deepti B. Pant, Elizabeth W. Karlson, Zihan Qian, and Andrea S. Foulkes. Additional authors include Kyung E Rhee, Cheryl R. Stein, Amy L. Salisbury, Patricia A. Kinser, Lawrence C. Kleinman, Richard Gallagher, David Warburton, Sindhu Mohandas, Jessica N. Snowden, Melissa S. Stockwell, Kelan G. Tantisira, Valerie J. Flaherman, Ronald J. Teufel, Leah Castro, Alicia Chung, Christine W Hockett, Maria Isidoro-Chino, Anita Krishnan, Lacey A. McCormack, Aleisha M Nabower, Erica R. Nahin, Johana M. Rosas, Sarwat Siddiqui, Jacqueline R. Szmuszkovicz, Nita Vangeepuram, Emily Zimmerman, Heather Elizabeth Brown, Megan Carmilani, K. Coombs, Liza Fisher, Margot Gage Witvliet, John C. Wood, Joshua D. Milner, Erika B. Rosenzweig, Katherine Irby, Michelle F. Lamendola-Essel, Denise C. Hasson, Stuart D. Katz, H. Shonna Yin, Rachel S. Gross and the RECOVER-Pediatrics Group Authors; for the RECOVER-Pediatrics Consortium.

Funding: This research was funded by NIH agreements OT2HL161841, OT2HL161847, and OT2HL156812. Additional support came from grant R01 HL162373. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the RECOVER Program, the National Institutes of Health, or other funders.

Paper cited: Rhee K et al. “Social Determinants of Health and Pediatric Long COVID in the United States” JAMA Pediatrics DOI: 10.1001/jamapediatrics.2025.5485

For More Information:

Long COVID in Children and Adolescents Research

Research Spotlight: Vaccinated Teens Face Lower Risk of Long COVID, Study Suggests

Study Reveals Insights into Long COVID Trajectories in Adults

Risk of Long COVID Increases with Social and Economic Hardship

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About Mass General Brigham

Mass General Brigham is an integrated academic health care system, uniting great minds to solve the hardest problems in medicine for our communities and the world. Mass General Brigham connects a full continuum of care across a system of academic medical centers, community and specialty hospitals, a health insurance plan, physician networks, community health centers, home care, and long-term care services. Mass General Brigham is a nonprofit organization committed to patient care, research, teaching, and service to the community. In addition, Mass General Brigham is one of the nation’s leading biomedical research organizations with several Harvard Medical School teaching hospitals. For more information, please visit massgeneralbrigham.org.

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Journal​

JAMA Pediatrics

DOI​

10.1001/jamapediatrics.2025.5485

Method of Research​

Data/statistical analysis

Subject of Research​

People

Article Title​

Social Determinants of Health and Pediatric Long COVID in the United States

Article Publication Date​

5-Jan-2026