Black, indigenous, and people of color (BIPOC) who were infected with COVID-19 experienced greater negative aftereffects in health and work loss than did similarly infected white participants, new research finds. 

Despite similar symptom prevalence, BIPOC and Hispanic patients experienced greater negative impacts on their health status, activity levels, and ability to work compared with non-Hispanic and white patients participating in the ongoing multi-site INSPIRE clinical trial examining people with long COVID.

The findings are published in the journal Frontiers in Public Health. 

“We must understand what is driving these differences in order to advance health equity after infection,” said Dr. Joann Elmore, principal investigator of the UCLA INSPIRE study site and a professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA. “Several minority populations reported worse overall health, lower activity levels, or more missed work months after infection. While we can’t pinpoint the cause, we know that, historically, these populations may have a harder time accessing health care, which could complicate their recovery.” 

INSPIRE, funded by the Centers for Disease Control and Prevention, is a collaboration of eight geographically diverse major academic medical centers, including UCLA Health, seeking to better understand the long-term effects of COVID-19. INSPIRE participants self-reported their symptoms in a standardized questionnaire. The INSPIRE group has been studying COVID-19 since the first documented U.S. case was found just outside the Seattle area in January 2020. This is the seventh research study released by the INSPIRE group.

For this latest study, the authors investigated the longer-term impacts of acute COVID-19 infection across ethnic and racial groups. They longitudinally followed 2,402 U.S. individuals first infected between 2020 and 2022. Study participants were asked to record their symptoms from a list of 22, including loss of taste, shortness of breath, and sore throat. While the investigators found few symptomatic differences across the groups at three- and six-months after infection, there were significant health effects and work loss among BIPOC populations.

The researchers suggest that some of these negative outcomes among BIPOC participants — when compared with those of non-Hispanic and white participants — may be associated with socioeconomic disparities. 

“Certain demographic groups may be overrepresented in front-line work industries,” said Dr. Michelle L’Hommedieu, project director for the UCLA INSPIRE study and co-author on this paper.  ”Keep in mind that individuals in these groups may not have had the option to work from home, which may have increased their risk of infection.” 

Other differences across population groups might stem from the lack of health insurance, mistrust of the medical establishment, cultural or institutional racism, medical deserts, or the lack of safe parks or green spaces where study participants live, the researchers noted. 

Among the findings:

• Hispanic participants were about twice as likely as non-Hispanic counterparts to self-report fair or poor health and much lower activity levels at three months. These differences, however, were no longer present at six months.
• Compared with white participants, those who identified as “other/multiple race” were nearly twice as likely to report fair or poor health and describe that they were somewhat or much less active at three months. These differences persisted at 6 months. The “other/multiple race” group included individuals identifying as American Indian or Alaska Native, Native Hawaiian or Pacific Islander or selecting two or more races.
• Compared with white participants, Asian participants’ chances of reporting fair/poor health was similar at three months, but Asian participants were more likely to report fair/poor health at six months.
• Reports of more than five missed workdays was similar across all race groups at three months; at six months, however, reports of missed work were almost three times higher among Black participants and two times higher other/multiple race participants.

The researchers described these differences in the context of accounting for other demographic factors that affect populations, such as social determinants of health, substance use, preexisting health conditions, and COVID-19 vaccination status. 

“Our hope is that these findings will inform equitable health interventions for underserved populations who are still navigating the post-COVID experience,” Elmore said.

This work was supported by the Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (75D30120C08008).