Abstract Rationale Socioeconomic and racial factors may significantly determine long COVID care, but their impact on healthcare utilization remains unclear. We evaluated the associations of insurance, income, employment, race, and ethnicity with healthcare utilization over 24 months among patients with long COVID. Methods We conducted a retrospective cohort study across the Mount Sinai Health System, including adults who met long COVID diagnostic criteria who had ≥1 ambulatory visit between 9/2020 and 1/2025. We collected insurance status (commercial/Medicare/Medicaid/uninsured), employment status (employed/unemployed/disability), race/ethnicity (self-reported), and household income. Primary outcomes: number of urgent care (UC) and emergency department (ED) visits at 6/12/24 months. Secondary outcomes: hospitalization counts, ICU admission, and initiation of supplemental oxygen therapy within 24 months. Analysis: Negative binomial regression estimated incidence rate ratios (IRRs) for UC, ED, and hospitalization counts. Logistic regression estimated adjusted odds ratios (ORs) for 24-month ICU admission and 24-month supplemental oxygen therapy. Models adjusted for age, sex, race/ethnicity (where not the exposure), BMI, smoking, Charlson Comorbidity Index (CCI), vaccination status and baseline dyspnea (mMRC). P-values were adjusted for multiple comparisons using the Benjamini-Hochberg procedure. Results A total of 1617 patients were included (median age: 54 years; 62. 1% female; 31. 0% ever-smokers; 32. 7% obese), race: 54. 5% White, 19. 8% Black, 19. 8% Asian, 4. 8% multiracial, and 14. 0% other, ethnicity: 21. 8% Hispanic. Most patients (92. 0%) were insured: 61. 1% private insurance, 17. 2% Medicare, and 18. 4% Medicaid. Median income distribution: under 25, 000: 19. 3%, between 25, 000-60, 000: 14. 7%, between 60, 000-150, 000: 28. 1%, and over 150, 000: 20. 5%, and 59. 6% were employed. Compared with uninsured patients, insured patients had higher counts of UC visits by 24 months (IRR: 4. 517; p=0. 023) but no significant increase in ED visits (IRR: 1. 734; p=0. 458) or hospitalizations (IRR: 1. 498; p=0. 999) by 24 months. Moreover, higher-income quintiles were associated with lower counts of ED visits by 24 months (IRR: 0. 606; p=0. 040) but unchanged counts of UC visits (IRR: 1. 003; p=0. 998) or hospitalizations (IRR: 0. 551; p=0. 232) by 24 months. Race, ethnicity, employment status and type of insurance were not associated with any of the primary or secondary outcomes. Conclusions Uninsured and low income status were independently associated with higher ED visits and acute care utilization over a 24-month period in patients with long COVID. Targeted outreach, insurance navigation, and community-aligned care pathways are warranted to prevent avoidable acute care use. This abstract is funded by: None
Goto et al. (2026) studied this question.