Food Insecurity and Adverse Social Conditions Tied to Increased Risk of Long COVID in Children

• Mass General Brigham researchers looked at data on 4,584 participants across 52 U.S. sites from the federally funded RECOVER-Pediatrics study
• Results identified social risk factors associated with greater odds of prolonged SARS-CoV-2 symptoms

New research led by Mass General Brigham investigators suggests that long COVID is more prevalent in school-aged children and adolescents who experience economic instability and adverse social conditions. The multi-center, observational study found that the risk of long COVID was significantly higher in households that faced food insecurity and challenges such as low social support and high levels of discrimination. Results are published in JAMA Pediatrics.

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

Social determinants of health (SDOH) are non-medical factors that stem from the environment in which a person lives and interacts with others. Prior research has either been conducted in adults or focused largely on how adverse SDOH can impact the risk of getting sick with COVID-19. However, experts estimate that millions of children around the world experience prolonged COVID symptoms, highlighting the need to examine the link between adverse SDOH and pediatric long COVID.

Seeking answers, the research team analyzed data from a subset of the federally funded RECOVER (Researching COVID to Enhance Recovery) Initiative. The cohort included 903 school-aged children and 3,681 adolescents with history of SARS-CoV-2 infection, who were recruited at 52 sites across the U.S. The study examined associations between long COVID and 24 social risk factors, grouped into five main domains: economic stability (e.g., food insecurity, poverty), social and community context (e.g., caregiver marital status, discrimination), caregiver education access and quality, neighborhood and built environment, and healthcare access and quality.

The researchers found that economic instability and poor social context, like difficulty covering expenses or facing discrimination, mattered most and had the greatest impact on risk of long COVID. By contrast, food security was protective, even for families with other economic challenges.

The authors speculate that healthy diets may decrease inflammation and thus protect against risk of long COVID. Further research is needed to investigate whether addressing these adverse social factors can mitigate future disease risk.

Authorship: In addition to Thaweethai, Mass General Brigham authors include Deepti B. Pant, Elizabeth W. Karlson, Zihan Qian, and Andrea S. Foulkes. Additional authors include Kyung E Rhee, Cheryl R. Stein, Amy L. Salisbury, Patricia A. Kinser, Lawrence C. Kleinman, Richard Gallagher, David Warburton, Sindhu Mohandas, Jessica N. Snowden, Melissa S. Stockwell, Kelan G. Tantisira, Valerie J. Flaherman, Ronald J. Teufel, Leah Castro, Alicia Chung, Christine W Hockett, Maria Isidoro-Chino, Anita Krishnan, Lacey A. McCormack, Aleisha M Nabower, Erica R. Nahin, Johana M. Rosas, Sarwat Siddiqui, Jacqueline R. Szmuszkovicz, Nita Vangeepuram, Emily Zimmerman, Heather Elizabeth Brown, Megan Carmilani, K. Coombs, Liza Fisher, Margot Gage Witvliet, John C. Wood, Joshua D. Milner, Erika B. Rosenzweig, Katherine Irby, Michelle F. Lamendola-Essel, Denise C. Hasson, Stuart D. Katz, H. Shonna Yin, Rachel S. Gross and the RECOVER-Pediatrics Group Authors; for the RECOVER-Pediatrics Consortium.

Funding: This research was funded by NIH agreements OT2HL161841, OT2HL161847, and OT2HL156812. Additional support came from grant R01 HL162373. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the RECOVER Program, the National Institutes of Health, or other funders.

Paper cited: Rhee K et al. “Social Determinants of Health and Pediatric Long COVID in the United States” JAMA Pediatrics DOI: 10.1001/jamapediatrics.2025.5485

For More Information:

• Long COVID in Children and Adolescents Research
• Research Spotlight: Vaccinated Teens Face Lower Risk of Long COVID, Study Suggests
• Study Reveals Insights into Long COVID Trajectories in Adults
• Risk of Long COVID Increases with Social and Economic Hardship