INTRODUCTION
The long-term consequences of SARS-CoV-2 infection, known as long COVID or post-COVID-19 condition (PCC), have emerged as a significant public health concern worldwide. In France, the burden of long COVID on individuals' quality of life remains a pressing issue, particularly as it interacts with socioeconomic disparities. This study investigates the role of socioeconomic position (SEP) in modulating the relationship between PCC and health-related quality of life (HRQoL) using data from a representative sample following the Omicron wave in autumn 2022. Through the application of the PROMIS-29 questionnaire across eight HRQoL domains, the research aims to uncover how variables like education, employment, income, and geographic origin shape the lived experience of long COVID in the French population. The study not only quantifies the impact but also explores equity and vulnerability across social strata, highlighting the importance of integrating socioeconomic perspectives into public health responses and healthcare strategies for long COVID.
RESEARCH DESIGN AND METHODOLOGY
The study utilized a cross-sectional, population-representative design to examine long COVID’s impact on HRQoL post-Omicron. A total of 1,448 adults previously infected with SARS-CoV-2 were surveyed, integrating robust demographic and socioeconomic data. The research adopted the WHO definition of PCC and employed the PROMIS-29 instrument to measure HRQoL across domains like physical function, pain, sleep, and mental well-being. A conceptual model was proposed to test how modifying factors—including age, sex, and SEP indicators such as education, employment status, and income—alter the relationship between PCC and HRQoL. Advanced statistical modeling techniques allowed for the analysis of interaction effects and helped identify subgroups with the most severe impacts.
SOCIOECONOMIC DETERMINANTS OF HRQOL
SEP was found to be a critical determinant in the relationship between long COVID and HRQoL. Individuals with low educational attainment and lower household income reported significantly greater reductions in quality of life across five PROMIS-29 domains, particularly in depression, fatigue, and social participation. These findings underscore the systemic vulnerability of marginalized groups to post-infection consequences. The study also revealed that business owners, unemployed individuals, and those from mainland France suffered disproportionately, suggesting economic instability and regional disparities amplify PCC-related health burdens. SEP is therefore not just a background factor but a core component influencing HRQoL outcomes post-COVID.
IMPACT OF EMPLOYMENT STATUS AND OCCUPATIONAL CATEGORY
Among the SEP indicators, employment status and occupational category were key modifiers. Unemployed individuals and self-employed persons, including entrepreneurs, exhibited greater HRQoL impairment than other employment groups. This pattern may be attributed to financial insecurity, lack of health coverage, and reduced social support. Moreover, these findings raise important considerations for labor policies and workplace support systems in mitigating the impact of long COVID, especially in populations whose income and well-being are tightly coupled to continuous employment or business viability.
REGIONAL AND EDUCATIONAL DISPARITIES
Geographic origin and educational attainment significantly modified the PCC-HRQoL relationship. Participants from mainland France experienced more pronounced declines in HRQoL, pointing to regional disparities that may stem from differences in healthcare access, economic infrastructure, or social services. Similarly, individuals without a long tertiary education were more vulnerable to PCC-related impairments. These disparities indicate that educational and regional policy interventions must be integrated into public health responses to long COVID to ensure equitable recovery and resilience across diverse French communities.
POLICY IMPLICATIONS AND RECOMMENDATIONS
The study’s findings carry significant implications for healthcare providers and policymakers. The evidence clearly supports the need for targeted interventions that consider SEP when addressing long COVID. Public health strategies must go beyond clinical treatment and incorporate social support, income assistance, and educational outreach to mitigate long COVID’s unequal burden. Special attention should be given to unemployed individuals, low-income families, and those with limited education. Policymakers are urged to design equity-focused programs to strengthen HRQoL recovery for all, especially for the socially and economically vulnerable populations.
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HASHTAGS:
#LongCOVID, #PostCOVID19Condition, #HealthInequality, #SocioeconomicStatus, #HRQoL, #PublicHealthFrance, #PROMIS29, #COVIDRecovery, #HealthEquity, #HealthPolicy, #OmicronWave, #FrenchHealthStudy, #SocialDeterminants, #HealthResearch, #ChronicCOVID, #IncomeAndHealth, #EmploymentHealthLink, #MentalHealthCOVID, #EducationAndHealth, #PCCImpact,
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