Long COVID and Chronic Health Conditions: A Growing Health Disparity

Background/Purpose: Long COVID emerged during the COVID-19 pandemic as a new chronic health condition faced by millions worldwide. In the United States, studies have highlighted social disparities in this new health condition, where women, Black and Hispanic people, older adults, and those with pre-existing health conditions are more likely to experience long COVID. For individuals facing other chronic health conditions or illness, long COVID has the potential to increase disability and difficulties accessing appropriate health care. Long COVID symptoms are diverse and treatment often requires multiple specialists, especially for individuals with pre-existing conditions. These challenges have been further exacerbated by the 2025 closure of the HHS Office of Long COVID Research. This study uses nationally representative data to document the prevalence and persistence of long COVID among adults with different chronic illnesses in the United States and to explore the impact of additional risk and protective factors.

Method: We use the 2023-2024 waves of the National Health Interview Survey, a nationally representative dataset that monitors US population health, to examine long COVID burden among adults with chronic illnesses including overall prevalence and persistence of symptoms as compared to individuals without reported chronic illness (NCHS, 2025). We use multivariate logistic regression models to estimate predicted probabilities of any long COVID symptoms lasting 3 months or longer, current long COVID symptoms, and long COVID impact on daily activities. We adjust for sociodemographic factors, race and ethnicity, health insurance, and COVID-19 vaccination status and also include interaction terms between chronic conditions and these variables.

Results: Adults with a chronic illness were more likely to report long COVID symptoms, and the prevalence varied by condition. The adjusted predicted probability models show the highest levels of reported long COVID among immunocompromised adults (23.2%), lung disease including asthma and COPD (20.3%), kidney disease (19.7%), and cardiovascular disease (19.5%). Overall adults with any chronic illness had a significantly higher probability of long COVID than those without a chronic illness (17.0% vs. 10.3%). We also found that these patterns were similar for persistent long COVID symptoms and long COVID impact on daily activities. It is also worth noting that in interaction models, poverty status significantly increased the likelihood that individuals with chronic illness also experience long COVID, while the COVID-19 vaccine modestly, but significantly, reduced the likelihood.

Conclusion: Adults with chronic illness are more likely to experience long COVID symptoms and this likelihood varies by the type of condition. We also found that individuals with chronic health conditions were more likely to have persistent symptoms that didn’t go away after 3 months and that their long COVID symptoms were impacting daily activities. These patterns were exacerbated for those living in poverty, though our analysis cannot assess whether or not poverty is a cause or result of long COVID given the cross-sectional data. Our findings suggest urgent consideration for reinstating funding to support a significant population of adults with chronic illness who are experiencing long lasting symptoms following COVID infections.