Regional Disparities in Functional and Socioeconomic Impacts of Long COVID in Brazil: A Cross-Sectional Observational Study

Abstract

Introduction and Objective: In low- and middle-income countries such as Brazil, regional inequalities in healthcare access and socioeconomic conditions may exacerbate the functional and occupational consequences of Long COVID. This study explored between-center differences in functional and socioeconomic outcomes among individuals with Long COVID from three Brazilian centers in Brazil, while examining how these findings may have been influenced by acute disease severity, symptom burden, and contextual factors. Methods: This was a cross-sectional study conducted with individuals diagnosed with Long COVID from three Brazilian regions (Federal District, Goi & aacute;s, and Sergipe). Functional limitations were assessed through the 6-Minute Step Test (6MST) and muscle strength via Handgrip Strength (HGS). Additionally, cardiorespiratory responses and work productivity impairments were evaluated. Results: A total of 142 participants were included: 47 from the Federal District, 59 from Goi & aacute;s, and 36 from Sergipe. Most participants were classified as non-critical (n = 129), while 13 were classified as critical, all from the Federal District. Significant differences in 6MST performance were observed across regions (p < 0.005). Critical patients exhibited lower SpO(2) at rest and peak compared to non-critical patients from Goi & aacute;s and Sergipe (mean difference: -4%; 95% CI: -6% to -2%). Non-critical patients from Sergipe had higher peak systolic (+25 mmHg; 95% CI: +20 to +30 mmHg) and diastolic blood pressure (+16 mmHg; 95% CI: +14 to +18 mmHg). Critical patients showed work productivity loss (-2.8%; 95% CI: -4.6% to -1.0%) compared to non-critical patients from Goi & aacute;s. Weak negative correlations were found between peak SpO(2) in the 6MST and age (r = -0.25; p = 0.01) and between HGS and HADS scores for anxiety (r = -0.20; p = 0.05) and depression (r = -0.20; p = 0.04). Discussion: Long COVID was associated with heterogeneous functional and socioeconomic impairments across the evaluated centers; however, these findings should be interpreted cautiously, as regional comparisons were substantially confounded by the unequal distribution of acute disease severity.