Exploring Long COVID diagnostic equity by sex, race and ethnicity, and insurance type

Our study explored Long COVID diagnostic inequity by comparing the demographic profile of patients diagnosed with Long COVID to patients diagnosed with COVID-19. Using electronic health record data from Advocate Health-Midwest between March 1, 2020, to November 1, 2023, we compared the proportion of all patients with documentation of Long COVID versus COVID-19 by race/ethnicity, sex, insurance type, and varying combinations of these characteristics. Relative to COVID-19, a greater proportion of patients diagnosed with Long COVID were female (63.7% vs. 58.0%), non-Hispanic (NH) White (66.4% vs 62.9%), or covered by private insurance (53.8% vs 51.3%), and a lower proportion were Hispanic (12.1% vs. 14.3%) or covered by Medicaid (11.9% vs. 14.3%). Among patients with Medicaid, NH Black patients were underrepresented by 5.4 percentage points in the Long COVID sample vs. COVID-19 (25.2% vs. 30.6%), while NH White patients were overrepresented by 6.7 percentage points in the Long COVID sample compared to COVID-19 (48.2% vs. 41.5%). Long COVID diagnostic estimates may be skewed towards patients that are more willing and able to seek care, while patients who experience multiple forms of disadvantage may be at risk for underdiagnosis due to compounding barriers to diagnosis. • Black and publicly-insured patients were underrepresented in the Long COVID sample. • Long COVID prevalence rates may be impacted by disparities in access to care. • Barriers to care may compound, which decreases likelihood of Long COVID diagnosis.