Modeling the relative influence of socio-demographic variables on post-acute COVID-19 quality of life: an application to settings in Europe, Asia, Africa, and South America

Long-term COVID-19 complications are a globally pervasive threat, but their plausible social drivers are often overlooked. Here, using data from a multinational prospective cohort (focusing on Norway, the UK, and Russia), we 1) ranked social and clinical predictors of quality of life (QoL) with long COVID and 2) measured the extent to which clinical intermediates explain any observed relationships between social variables and long COVID QoL. We found that, in addition to age, neuropsychological, and rheumatological comorbidities, educational attainment, employment status, and sex were consistently identified as top predictors of long COVID-associated utility scores, a measure of quality of life. Furthermore, 98.2% (95% CI: 87.3%, 100%) and 89.4% (74.6%, 99.6%) of the adjusted associations between high educational attainment or full-time employment and long COVID utility scores was unexplained by key long COVID-predicting comorbidities in Norway and the UK. The same was true for 84.2% (46%, 100%), 67.6% (45.5%, 89.7%), and 87.2% (71.3%, 100%) of the adjusted associations between female sex and long COVID utility scores in Norway, the UK, and Russia. Thus, socio-economic proxies and sex can be as predictive of long COVID QoL, not fully attributable to commonly emphasized comorbidity pathways, and warrant increased focus in long COVID-targeting efforts.