Economic Instability Heightens Risk of Pediatric Long COVID

Investigators from Massachusetts General Brigham found that long COVID is more likely in children and adolescents who experience adverse social conditions and economic instability, according to results from their multicenter, cross-sectional, observational study published in JAMA Pediatrics.^1,2

Food Insecurity Is a Key Risk Factor of Long COVID Development

The study investigated 4584 school-aged children (n = 903) and adolescents (n = 3681) with a history of SARS-CoV-2 infection across 52 health care and community settings in the United States. Patients were recruited from March 2022 to August 2024 through multiple avenues, including via health care systems, long COVID clinics, flyers, websites, community-based organizations, and existing research cohorts such as the Researching COVID to Enhance Recovery (RECOVER) Initiative.¹

Following the adjustment of numerous factors—including age group, sex, and timing of infection—the authors found that economic instability was associated with an increased risk of having long COVID (class 2 adjusted odds ratio [aOR], 1.57; 95% CI, 1.18–2.09; class 4 aOR, 2.39; 95% CI, 1.73–3.30). Specifically, instability characterized by food insecurity, receiving government assistance, difficulty covering expenses, and poverty increased long COVID risk in this cohort.¹

Interestingly, economic instability without corresponding food insecurity was not associated with an increased long COVID risk (aOR, 0.93; 95% CI, 0.70–3.30). This demonstrates the outsized importance of nutrition on immune function and metabolic health and the key role it plays in reducing the severity or risk of both SARS-CoV-2 infection and long COVID.^1,3

Poorer social and community context—for example, experiencing high levels of discrimination and low social support—was associated with a heightened risk of long COVID (aOR, 2.17; 95% CI, 1.77–2.66). The investigators confirmed the accuracy of the results following sensitivity analyses stratified by age group and adjusted for ethnicity and race, which did not attenuate the results.¹

“Long COVID in children is especially concerning because of the potential for long-term health effects that could persist into adulthood,” Tanayott Thaweethai, PhD, co-first author and researcher at Massachusetts General Hospital Biostatistics, said in a news release accompanying the study results. "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."²

What Pharmacists Should Know

Individuals with an unknown date of their first infection, a history of multisystem inflammatory syndrome in children, or symptom surveys with less than 50% of questions completed were excluded from the study to ensure a clear picture of the results. A total of 24 social risk factors, grouped into 5 main domains, were ultimately examined: economic stability, social and community context, caregiver education access and quality, neighborhood and built environment, and health care access and quality.^1,2

Future research efforts could seek to expand the number of social risk factors that may impact children and adolescents, thereby painting a more thorough picture of the constellation of social determinants of health (SDOH) that patients must navigate. The current research effort, however, adds valuable context to how pharmacists and clinicians understand long COVID. The data could inform efforts to better treat the condition and provide tailored counseling points for patients seeking to reduce their risk of long COVID.²

In this regard, pharmacists are pivotal. They are in a prime position to explain to caregivers the importance of a healthy diet and adequate nutrition to keeping the immune system strong and protective. Inflammation is a critical aspect contributing to the development of long COVID; ensuring children are receiving proper nutrition, in addition to making sure their social and neighborhood environments are adequate, is a key counseling point for pharmacists when discussing long COVID with families impacted.^1,2

“Further study is needed to determine if addressing SDOH factors can decrease the rate of pediatric long COVID,” the investigators concluded.¹

REFERENCES

1. Rhee KE, Thaweethai T, Pant DB et al. Social determinants of health and pediatric long COVID in the US. JAMA Pediatr. Published Online January 5, 2026. Accessed January 16, 2026. doi:10.1001/jamapediatrics.2025.5485

2. Food insecurity and adverse social conditions tied to increased risk of long COVID in children. News Release. Brigham and Women’s Hospital. EurekAlert! Released January 5, 2026. Accessed January 16, 2026. https://www.eurekalert.org/news-releases/1111336

3. Younes S. The role of nutrition on the treatment of COVID-19. Human Nutrition & Metabolism. 2024;36:200255. doi:10.1016/j.hnm.2024.200255