Identifying Potential Vulnerability to Long COVID Through Global‐to‐Local Inequalities in Years Lived With Disability Attributed to COVID‐19, 2020–2021, Across 920 Locations

ABSTRACT The COVID‐19 pandemic has reshaped global health; however, the long‐term burden of long COVID remains poorly understood, especially in low‐ and middle‐income countries (LMICs), where limited surveillance and data gaps may obscure a substantial and sustained impact. Using the Global Burden of Disease (GBD) 2021 framework, we previously assessed the direct COVID‐19 burden—including incidence, prevalence, mortality, and disability‐adjusted life‐years (DALYs)—across 920 locations during 2020–2021. In this study, we focus on years lived with disability (YLDs), particularly in 2021, as a potential early indicator to identify locations and populations that may be at higher risk of long COVID burden in subsequent years (e.g., 2022–2023). We also examine patterns of inequality to highlight vulnerable groups. Our findings are consistent with multiple large‐scale studies on long COVID and suggest that YLDs may serve as a useful early proxy for ongoing burden. Importantly, we identify notably higher age‐standardized YLD rates in LMICs—especially in Sub‐Saharan Africa and in parts of South Asia and Eastern Europe. These areas, previously underexplored in long COVID research, might be particularly susceptible to its effects. Among the top 10 countries with the highest age‐standardized YLD rates in 2021, 80% fell within the low, low‐middle, and middle Socio‐demographic Index (SDI) categories. These high age‐standardized YLD rates may point to systemic vulnerabilities and entrenched structural health disparities, indicating a potential for considerable and enduring long COVID burden that could persist to the present day in the absence of targeted interventions. Furthermore, our inequality analysis underscores that while both advantaged and disadvantaged groups in LMICs require attention, the most disadvantaged groups warrant special focus due to their more severe resource constraints and restricted capacity for resilience‐building. Overall, this study supports calls for stronger surveillance, expanded access to rehabilitation, and better integration of long COVID care into universal health coverage. Continued GBD updates will be essential for monitoring trends and guiding responsive public health strategies.

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Journal
Med Research
Published
2025-08-03
DOI
https://doi.org/10.1002/mdr2.70023
Citations
8
Primary Topic
Long-Term Effects of COVID-19
Type
article
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11.11
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article

Identifying Potential Vulnerability to Long COVID Through Global‐to‐Local Inequalities in Years Lived With Disability Attributed to COVID‐19, 2020–2021, Across 920 Locations

Jianhua Huang, Ying Wang, Chengliang Yang, Ruhai Bai et al.
8 citations
Med Research
Long-Term Effects of COVID-19
11.11
article

Identifying Potential Vulnerability to Long COVID Through Global‐to‐Local Inequalities in Years Lived With Disability Attributed to COVID‐19, 2020–2021, Across 920 Locations

Jianhua Huang, Ying Wang, Chengliang Yang, Ruhai Bai, Azeem Majeed, Scott J. Tebbutt, Baozhen Huang, You Zeng, Qianyun Lin, Dong Wang, Qiaoyu Shao, Lerong Chen, Ruiling Xie, Guangyao Cai, Ningning Wu, Qingjia Zeng, Zimeng Wu, Dan Shan, Changchang Li, Zhihui Li, Fei Li, Christine Linehan, Liang Zhang, Minzhi Lv, Weize Xu, Wenyi Jin, Xian Shao, Yuanyuan Chen, Salman Rawaf, Haowei Wang, Wei Wang, Yi Chen, Ting Luo, Yue Qiu, Xiaozhu Liu, Shuang Hu, Claire Chenwen Zhong, Lili Zheng, Tongrui Shang, Wen Chen, Yuanyuan Wan
article en
8 citations

Abstract

ABSTRACT The COVID‐19 pandemic has reshaped global health; however, the long‐term burden of long COVID remains poorly understood, especially in low‐ and middle‐income countries (LMICs), where limited surveillance and data gaps may obscure a substantial and sustained impact. Using the Global Burden of Disease (GBD) 2021 framework, we previously assessed the direct COVID‐19 burden—including incidence, prevalence, mortality, and disability‐adjusted life‐years (DALYs)—across 920 locations during 2020–2021. In this study, we focus on years lived with disability (YLDs), particularly in 2021, as a potential early indicator to identify locations and populations that may be at higher risk of long COVID burden in subsequent years (e.g., 2022–2023). We also examine patterns of inequality to highlight vulnerable groups. Our findings are consistent with multiple large‐scale studies on long COVID and suggest that YLDs may serve as a useful early proxy for ongoing burden. Importantly, we identify notably higher age‐standardized YLD rates in LMICs—especially in Sub‐Saharan Africa and in parts of South Asia and Eastern Europe. These areas, previously underexplored in long COVID research, might be particularly susceptible to its effects. Among the top 10 countries with the highest age‐standardized YLD rates in 2021, 80% fell within the low, low‐middle, and middle Socio‐demographic Index (SDI) categories. These high age‐standardized YLD rates may point to systemic vulnerabilities and entrenched structural health disparities, indicating a potential for considerable and enduring long COVID burden that could persist to the present day in the absence of targeted interventions. Furthermore, our inequality analysis underscores that while both advantaged and disadvantaged groups in LMICs require attention, the most disadvantaged groups warrant special focus due to their more severe resource constraints and restricted capacity for resilience‐building. Overall, this study supports calls for stronger surveillance, expanded access to rehabilitation, and better integration of long COVID care into universal health coverage. Continued GBD updates will be essential for monitoring trends and guiding responsive public health strategies.

Med ResearchVol. 1(2)
University College Dublin (IE), Sun Yat-sen University (CN), City University of Hong Kong (HK), Chinese University of Hong Kong (HK), Shanghai Jiao Tong University (CN), Capital Medical University (CN), Chinese Academy of Medical Sciences & Peking Union Medical College (CN), Sichuan University (CN), Fudan University (CN), Peking Union Medical College Hospital (CN), Shanghai Mental Health Center (CN), John Radcliffe Hospital (GB), Public Health England (GB), University of California San Diego (US), Nanjing University of Science and Technology (CN), University of Oxford (GB), West China Hospital of Sichuan University (CN), Nanjing Children's Hospital (CN), Sun Yat-sen Memorial Hospital (CN), Nanfang Hospital (CN), World Health Organization (CH), National Supercomputing Center in Shenzhen (CN), Children's Hospital of Zhejiang University (CN), Jiangxi Chest Hospital (CN), Beijing Anzhen Hospital (CN), Faculty of Public Health (GB), Vanke (China) (CN), Prevention of Organ Failure (CA), Second Affiliated Hospital of Nanjing Medical University (CN), Guangdong Province Women and Children Hospital (CN), St. Paul's Hospital (CA), Sun Yat-sen University Cancer Center (CN), Beijing Shijitan Hospital (CN), Tongji Hospital (CN), Imperial College London (GB), Huazhong University of Science and Technology (CN), Southern Medical University (CN), Nanjing Medical University (CN), Tsinghua University (CN)
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Long-Term Effects of COVID-19
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