Risk of long COVID and associated symptoms after acute SARS-COV-2 infection in ethnic minorities: a Danish nationwide cohort study

Abstract Background and aim Ethnic minorities living in high-income countries have been disproportionately affected by COVID-19 in terms of infection rates, hospitalisations, and deaths; however, less is known about long COVID in these populations. Our aim was to examine the risk of long COVID and associated symptoms among ethnic minorities. Methods We used Danish nationwide register-based cohort data on individuals diagnosed with COVID-19 aged ≥18 years (n = 2 334 271) between January 2020 and August 2022. We calculated the risk of long COVID diagnosis and long COVID symptoms among ethnic minorities compared with native Danes using multivariable Cox proportional hazard regression and logistic regression, respectively. Results Of the diagnosed COVID-19 cases, 1 973 998 (84.6%) were native Danes and 360 273 (15.4%) were ethnic minorities. After adjustment for age, sex, civil status, education, family income, and Charlson comorbidity index, ethnic minorities from North Africa (adjusted hazard ratio [aHR] 1.41, 95% CI [1.12,1.79]), Middle East (aHR 1.38, 95% CI [1.24,1.55]), Eastern Europe (aHR 1.35, 95% CI [1.22,1.49]), and Asia (aHR 1.23, 95% CI [1.09,1.40]), had significantly greater risk of long COVID diagnosis than native Danes. In the analysis by largest countries of origin, the greater risks of long COVID diagnosis were found in Iraqis (aHR 1.56, 95% CI [1.30,1.88]), Turks (aHR 1.42, 95% CI [1.24,1.63]), and Somalis (aHR 1.42, 95% CI [1.07,1.91]). A significant factor associated with an increased risk of long COVID diagnosis was COVID-19 hospitalisation. Conclusions Migrants and ethnic minorities had higher risk of long-COVID compared to native Danes.