Post-COVID Condition and Disparities in Daily Functional Activities: Findings from Virus Watch - a prospective community cohort study

BackgroundPost-COVID Condition (PCC) is increasingly recognised to impair daily functioning, particularly work ability, cognitive function, and self-care. This analysis investigates the role of deprivation, migration status, and ethnicity in experiencing limitations in six functional activities: work/education, concentration, self-care, caring for others, performing necessary activities outside the house, and engaging in enjoyable activities. MethodsWe analysed data from Virus Watch, a prospective community cohort study in England, identifying 776 individuals ([≥]18 years) with PCC between February 2020 and March 2024. We used logistic regression to assess how deprivation, migration and ethnic minority status were associated with the odds of experiencing each functional limitation, adjusting for sociodemographic variables. FindingsIndividuals with PCC in IMD 1 (the most deprived quintile) had higher adjusted odds of limitations in work/education, concentration, self-care, and doing necessary activities outside the house than those in IMD 5 (the least deprived) (adjusted odds ratio (aOR) range: 2{middle dot}20-2{middle dot}85). Those in IMD 2 also experienced increased odds of limitations in work/education and concentration compared to those in IMD 5. We found no evidence of associations between migration status or minority ethnicity with functional limitations among PCC individuals. InterpretationOur findings indicate that socioeconomic deprivation, rather than migration status or ethnicity, is the primary driver of functional limitations within this cohort. Functional limitations may perpetuate cycles of deprivation and further exacerbate health inequalities. Equitable access to rehabilitation and support services, alongside workplace and educational adaptations, is needed to address the functional limitations of those affected by PCC. FundingMedical Research Council; Wellcome Trust; European Union Research in contextO_ST_ABSEvidence before this studyC_ST_ABSWe searched PubMed and Web of Science for English-language articles indexed from March 2020 up to May 2025 on the association between deprivation, migration status, and ethnicity, and functional limitations of post-COVID condition (PCC). The search string ("post-COVID condition" OR "long COVID" OR "post-acute COVID-19" OR "post-COVID syndrome" OR "post-acute sequelae of SARS-CoV-2" OR PCC) AND (deprivation OR "Index of Multiple Deprivation" OR IMD OR "socioeconomic status" OR "social determinants" OR "social inequality" OR migration OR "migration status" OR migrant OR immigrant OR ethnicity OR "ethnic minority" OR race OR "racial group") AND ("functional limitation*" OR "functional impairment*" OR "activity limitation*" OR "participation restriction*" OR "functional status" OR "work ability" OR "work attendance" OR "school attendance" OR "work participation" OR "school participation" OR concentration OR "cognitive impairment" OR "brain fog" OR "self-care" OR "activities of daily living" OR ADL OR "caring for others" OR caregiving OR "leisure activities" OR "enjoyable activities" OR "social participation" OR "necessary activities outside the house" OR "instrumental activities of daily living" OR IADL) was used. The search identified several US-based studies reporting greater functional limitations among Black and Hispanic populations, but few data exist outside the US, and none addressed deprivation and migration status. We therefore excluded the search terms related to social determinants in a follow-up search to focus on the broader literature on functional limitations. Most studies focused on hospitalised populations and often lacked detail on specific functional activities. One UK-based study reported greater functional impairment, measured using the Work and Social Adjustment Scale, among individuals in the most deprived quintile compared to those in less deprived quintiles in the UK. However, the impact of migration status remains largely unexplored. Added value of this studyTo our knowledge, this is the first study to examine how deprivation, migration status, and ethnic minority status influence specific functional limitations among adults with PCC in England. By disaggregating specific daily activities, we found that individuals living in more deprived areas experience greater odds of limitations in work/education attendance or participation, concentration, self-care, and doing necessary activities outside the house compared to those living in the least deprived areas. In contrast, no disparities were observed for migrants or ethnic minorities. Our findings provide granular insights into the role of social determinants, particularly deprivation, in influencing the functional impacts of PCC, allowing the development of more targeted interventions and policy responses to support those most affected. Implications of all the available evidenceAlongside existing evidence, our findings highlight the need for targeted interventions to address the disproportionate impact of PCC on individuals in deprived communities. Policy responses should prioritise equitable access to rehabilitation and support services through adapted referral pathways and culturally appropriate outreach. Reforming statutory sick pay eligibility and ensuring the availability of flexible workplace or educational arrangements should also be ensured for those affected. Addressing these systemic barriers will prevent further widening of health inequalities and support a more equitable recovery from the long-term effects of COVID-19, while also informing future public health strategies for post-acute conditions.