NEW research in the USA indicates that adverse social determinants of health (SDOH) are linked to higher odds of long COVID in school-aged children and adolescents. The study highlights economic instability and poor social or community context as key risk factors, while children with food security were less affected even amid other economic challenges.
Millions of children worldwide are experiencing prolonged symptoms after SARS-CoV-2 infection, yet the social factors influencing long COVID remain poorly understood. This cross-sectional meta-cohort analysis sought to clarify how SDOH, conditions in which children live, learn, and interact, affect long-term post-COVID outcomes.
Economic Instability and Food Insecurity Raise Long COVID Odds
The study included 4,584 children aged 6–17 years across 52 USA healthcare and community sites. Researchers assessed 24 SDOH factors grouped into five domains from the Healthy People 2030 framework: economic stability, social and community context, caregiver education, neighbourhood environment, and health care access.
Adjusted analyses revealed that households experiencing economic instability, including difficulty covering expenses, poverty, government assistance, and food insecurity, had significantly higher odds of paediatric long COVID (adjusted odds ratios up to 2.39). Notably, economic challenges without food insecurity were not associated with increased risk, underscoring the critical impact of access to sufficient nutrition in mitigating post-COVID complications.
Poor Social and Community Context Also Contributes
Children living in environments with high levels of discrimination and low social support were more likely to develop long COVID (aOR: 2.17). The findings were consistent across age groups and remained robust after adjusting for race, ethnicity, infection timing, and other social domains. For clinicians, this suggests that screening for adverse social and community factors could help identify children at higher risk for prolonged post-infection symptoms.
Clinical Implications and Future Directions
For paediatricians and allied health professionals, these results highlight the importance of incorporating SDOH assessment into post-COVID care. Targeted interventions, such as connecting families to food support, social services, or community resources, may reduce long COVID risk in vulnerable populations. Further research is needed to determine whether addressing SDOH can directly prevent prolonged post-COVID illness in children.
Reference
Rhee KE et al. Social determinants of health and pediatric long COVID in the US. JAMA Pediatr. 2026; doi:10.1001/jamapediatrics.2025.
