Social and Economic Factors May Increase Long COVID Risk in Children

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Long COVID, a term used to describe ongoing symptoms that last weeks or months after a COVID-19 infection, is increasingly recognized in children and teens. While much of the focus has been on biological risk factors, a large U.S. study looked at something different: how a child’s social and economic environment may influence their risk of developing long COVID.

“Long COVID in children is especially concerning because of the potential for long-term health effects that could persist into adulthood,” said co-lead investigator Tanayott Thaweethai, Ph.D., of Massachusetts General Hospital Biostatistics.

Investigators analyzed data from more than 4,500 school-aged children (ages 6-11) and adolescents (ages 12-17) across 52 sites in the United States who had previously been infected with COVID-19. Caregivers completed detailed surveys between March 2022 and August 2024, reporting both their child’s symptoms and a wide range of social determinants of health (SDOH), including household finances, food access, social support, neighborhood conditions, education access and health care access.

The study, published in JAMA Pediatrics, found a strong link between certain adverse social determinants of health and a higher likelihood of pediatric long COVID. Children living in households with significant economic instability, such as difficulty paying bills, living in poverty or relying on government assistance, had higher odds of experiencing long COVID, especially when that instability included food insecurity. In fact, children from households facing economic hardship with food insecurity had up to more than twice the odds of long COVID (between 57% to 139%) compared with those experiencing the least adversity.

Importantly, the findings showed a key distinction: Children who experienced economic challenges but did not face food insecurity were not at higher risk for long COVID. This suggests that consistent access to food may play a protective role, even when families are under financial stress.

Social and community factors also mattered. Children and teens who lived in environments marked by low social support or high levels of discrimination were significantly more likely to develop long COVID symptoms. These effects were seen across both younger children and adolescents and remained consistent even after accounting for age, sex, timing of infection and other factors.

The study highlights that long COVID risk in children is shaped not only by the virus itself but also by the conditions in which children live, grow and recover. Addressing food insecurity, strengthening social support systems and reducing discrimination may be important steps in reducing the long-term impact of COVID-19 on children’s health.

The team mentioned some limitations of the study to keep in mind, such as the possibility that families facing greater social and economic challenges were less likely to participate. Other limitations included surveys being offered only in English and Spanish, possible errors in how symptoms were categorized and limited data on neighborhood-level conditions. They emphasized that future research is needed to figure out whether addressing these SDOH factors can reduce the rate of pediatric long COVID.

“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,” concluded Thaweethai.