COVID-19 recovery disparities uncovered among racial and ethnic groups

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In a recently published study, Dr Frontiers in Public HealthResearchers in the United States of America (US) investigated racial and ethnic disparities in symptoms, activity levels, health status, and missed work.

Image of SARS-CoV-2 virus
Study: Racial and ethnic differences in self-reported symptoms, health status, activity level, and missed work at 3 and 6 months after SARS-CoV-2 infection.. Image credit: Kateryna Kon/

They assessed this through follow-up after primary infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although symptoms were equally prevalent between the groups, they found that three and six months after infection, Hispanic participants reported poorer health and decreased activity than non-Hispanic participants.

Furthermore, ethnic minority participants reported more negative effects on health status, activity, and absence from work than did the white population.


The coronavirus disease 2019 (COVID-19) pandemic has highlighted disparities, with racial and ethnic minority populations found to face greater infection risks due to the essential nature of their work, limited remote work options, and challenges in practicing social distancing.

Infected individuals faced barriers to care, including low insurance and lack of primary care, with financial consequences. Disparities in health outcomes persisted, for example, with higher hospitalization and death rates among black and Hispanic populations.

Despite these challenges, recovery-related differences after SARS-CoV-2 infection remain understudied, with existing studies having limitations such as different follow-up periods, inconsistent results, and insufficient consideration of social health determinants.

In the current study, researchers aimed to address this gap. The study assessed symptoms and health-related impacts across race and ethnicity following SARS-CoV-2 infection, with the aim of effectively directing equitable health interventions.

About the study

In the current study, a secondary analysis was performed using data from a US-based, prospective, multi-center, longitudinal cohort study called Innovative Support for Patients with SARS-CoV-2 Infection Registry (INSPIRE). The primary cohort consisted of adults positive for SARS-CoV-2 infection enrolled from December 2020 to July 2022, with a SARS-CoV-2-negative group to consider non-SARS-CoV-2-related effects.

A total of 3,161 participants completed enrollment and reported symptoms and other outcomes via surveys every three months. Of these participants, 2,402 were SARS-CoV-2-positive and 759 were SARS-CoV-2-negative.

Among SARS-CoV-2-positive participants, 14.0% were Hispanic, 11.0% were Asian, 7.9% were black, 9.9% were classified as other/multiple races, and 71.1% were white. Among SARS-CoV-2-negative participants, 16.5% were Hispanic, 14.8% were Asian, 13.1% were black, 8.1% were classified as other/multiple races, and 64% were white.

Researchers assessed 21 Covid-19-like symptoms and “other symptoms” at enrollment and at three and six months post-infection using the Centers for Disease Control and Prevention Symptom Inventory.

During follow-up, health status (rated on a 5-point scale from excellent to poor), activity level (same, somewhat less, much less) compared to pre-Symptoms of SARS-CoV-2, and past three months of missed work (categorized into working days) was assessed.

Data on race and caste were collected. Interactions between race or ethnicity and SARS-CoV-2 infection status were considered.

Generalized estimating equation (GEE) logistic regression was used to estimate marginal odds ratios (ORs) for various outcomes, adjusting for SARS-CoV-2 infection status, demographic factors, substance use, social determinants of health, pre-existing health conditions, COVID-19 vaccination status, and survey time points.

Results and discussion

After SARS-CoV-2 infection, symptoms were found to be mostly similar across racial and ethnic groups over time. At three months, Hispanic individuals were more likely to report fair/poor health (OR = 1.94) and have decreased activity than their non-Hispanic counterparts. No significant differences by race were observed at six months.

At three months, other/multiple race participants were more likely to report fair/poor health (OR = 1.9) and have decreased activity than white participants. At six months, Asian participants were more likely to report fair/poor health (OR = 1.88), black individuals reported more missed work (OR = 2.83), and other/multiple race participants reported more health problems (OR = 1.83). decreased activity, and missed work (OR = 2.25).

The findings help improve our understanding of racial and ethnic disparities in outcomes after SARS-CoV-2 infection and can be used to inform clinical and public health initiatives and policy.

However, the study is limited by small sample sizes of racial and ethnic subgroups, lack of adjustment for insurance and frontline worker status, potential participant representation issues, variation in response rates, lack of exploration of neurological and mental health sequelae, recruitment to different epidemiology. phase, and absence of adjustment for multiple comparisons.


In conclusion, results suggest that while symptom prevalence was similar between groups, racial and ethnic minority groups suffered adverse effects on health status, activity level, and absence from work compared to non-Hispanic and white populations, respectively.

Examining the underlying factors contributing to these differences can help improve efforts to promote health equity and our preparedness for future epidemics.

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