A new survey of more than 21,000 US adults shows that those who reported food insecurity had a 73% higher chance of reporting post–COVID-19 condition, or long COVID.

The study was published yesterday in JAMA Network Open and adds to a growing body of literature that links food insecurity with delayed or forgone medical care, worsened mental health, and racial disparities during the COVID-19 pandemic, the authors said. This is the first known study to link food insecurity to long COVID.

The study was based on data from the 2022 to 2023 National Health Interview Survey (NHIS) data, unemployment records, and enrollment in the Supplemental Nutrition Assistance Program (SNAP).

According to the authors, approximately 13.5% of US households were food insecure in 2023, and there was a monthly average of 42.1 million SNAP participants in 2023. Food insecurity is generally defined as not having access to sufficient food to meet people’s basic needs.

Authors call for investment in SNAP

The 21,631 survey participants were asked if they had current long COVID (yes or no) and whether they had a history of and recovered from long COVID (yes or no). Long COVID was defined as self-reported symptoms persisting for more than 3 months after initial COVID-19 diagnosis.

The participants also used the 10-item National Center for Health Statistics food insecurity scale, with 0 to 2 indicating high or marginal food security, and scores of 3 to 10 indicating low or very low food security. The core questions for the scale cover experiences such as worrying about food running out, not being able to afford balanced meals, and skipping meals owing to a lack of money.

In total, 19,824 participants (92%) had food security, and 1,807 (8%) reported food insecurity. Fifty-three percent of participants were female, and 64% were non-Hispanic White. Sixteen percent were 65 years or older.

Of those with food insecurity, 32% participated in SNAP. Most adults receiving SNAP (60%) were not employed, compared with 37% not receiving SNAP.

Food insecurity showed a large positive association with current long COVID (odds ratio [OR], 2.46; 95% confidence interval [CI], 2.05 to 2.96). And the associated remained significant after adjusting for covariates (adjusted OR, 1.73; 95% CI, 1.39 to 2.15)—for a 73% higher risk. Unemployment, female sex, and former or current smoking was also associated with long COVID.

“Food insecurity was not significantly associated with current long COVID among individuals receiving SNAP benefits or unemployed individuals. However, food insecurity was associated with current long COVID among those not receiving SNAP,” the authors wrote.

“With the long-term costs of long COVID estimated to be $2.6 trillion, investing in SNAP represents a cost-effective strategy to reduce its burden and improve population health,” they concluded.