Date of Award

January 2026

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Harlan Krumholz

Second Advisor

Mitsuaki Sawano

Abstract

Background: Long COVID is characterized by persistent symptoms following SARS-CoV-2 infection that can impair daily functioning and quality of life. While biological mechanisms have been proposed, they do not fully explain variation in symptom burden and recovery among individuals with long COVID. Socioeconomic conditions may also influence how individuals experience chronic illness following infection.Research aim: This study examined whether self-reported pandemic-related financial hardship was associated with differences in participant-reported illness burden and perceived recovery among individuals living with long COVID in the Yale LISTEN cohort. Question: Among individuals living with long COVID, were higher levels of participant-reported pandemic-related financial hardship associated with differences in symptom severity, self-rated general health, and perceived recovery during follow-up? Methods: A retrospective secondary analysis of longitudinal survey data from the Yale LISTEN cohort was conducted among participants who completed both enrollment and follow-up surveys and provided a response to a self-reported measure of financial difficulty attributed to the COVID-19 pandemic. Financial hardship was categorized as no hardship, little hardship, or high hardship. Participant-reported outcomes included symptom severity on a 0-100 scale and self-rated general health at enrollment and follow-up, as well as perceived recovery at follow-up. Analyses compared these outcomes across financial hardship groups at each timepoint and descriptively evaluated differences in symptom change and perceived recovery. Comparisons across groups were performed using chi-square and Kruskal-Wallis tests. Results: Among 318 participants included in the analytic sample, 30% reported no financial hardship, 38% reported little hardship, and 32% reported high hardship. Participants reporting greater financial hardship had higher symptom severity, poorer self-rated general health, and lower rates of perceived recovery. Median symptom severity scores were higher among participants reporting greater hardship at both enrollment (72 vs 80 vs 84; p < 0.001) and follow-up (70 vs 77 vs 80; p = 0.004). Recovery at follow-up was reported by 31%, 25%, and 11% of participants, respectively (p = 0.002). Symptom severity improved across all groups, with no significant differences in the magnitude of change over time (p = 0.482). Scientific impact and relevance for communities of interest, including patients: Greater pandemic-related financial hardship was associated with worse participant-reported illness burden among individuals with long COVID, including higher symptom severity, poorer general health, and lower rates of perceived recovery. These findings highlight the importance of considering socioeconomic context when evaluating patient-reported outcomes, although the observational design and potential confounding limit causal interpretation.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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