Prevalence of post COVID-19 condition and associations with risk factors among U.S. Adults: 2023 Behavioral Risk Factor Surveillance System

Gregory Wayne Heath^1*David Levine²Majdi Alghader²Gloria Oppong²

• ¹University of Tennessee at Chattanooga, Chattanooga, United States
• ²The University of Tennessee at Chattanooga, Chattanooga, United States

Introduction: During the COVID-19 pandemic there emerged between 12%-20% of US adults who were identified as having post COVID19 condition, commonly referred to as 'Long COVID', who manifested symptoms of COVID-19 three months or longer following their illness but lacked an active infection. Using the Center for Disease Control's 2023 Behavioral Risk Factor Surveillance System, our hypotheses were that adults not meeting the 2018 Physical Activity Guidelines for Americans for aerobic activity and strengthening activity, not being fully vaccinated for COVID-19, and those having certain non-communicable diseases would be at greater odds of reporting post COVID-19 conditions. Methods: The association of post COVID-19 conditions were examined among the 46.4% of adults 18 years and older who had tested positive for COVID-19 (n = 201,248) with a subset these adults reporting post COVID-19 conditions (n = 27,074, 13.6%). Univariate and logistic regression analyses were conducted using SPSS (v29) for complex samples. Univariate analyses were conducted initially among both behavioral risk factors and multiple non-communicable diseases. Subsequently, a series of logistic regression analyses controlling for age, sex, race/ethnicity, and educational attainment comparing the outcome variable of post COVID-19 conditions with the exposure variables of 1) not meeting the Physical Activity Guidelines for Americans; 2) not being fully vaccinated; and 3) having the non-communicable diseases of overweight/obesity, coronary heart disease, asthma, and hypertension. Results: Adults (n = 13,449; 12.2%) who did not meet the Physical Activity Guidelines for Americans were at greater odds of reporting post COVID-19 conditions (aerobic activity – OR = 1.19, 95% CI 1.06, 1.33, p<0.0001; strengthening activity - OR = 1.02, 95% CI 1.00, 1.03, p<0.001) compared with those meeting the guidelines. Respondents not being fully vaccinated (< 3 vaccinations) compared with those reporting > 4 vaccinations were at greater odds of reporting pos (OR =1.42, 95% CI, 1.24, 1.49, p<0.0001). Discussion: The present findings support the hypothesis that adults: who were female; did not achieve the Physical Activity Guidelines; were not fully vaccinated; and had certain non-communicable diseases demonstrated a stronger association with reporting post COVID-19 conditions following COVID-19 infection.