Self-Reported Long COVID-19 Among HUD-Assisted Adults: Preliminary Findings from the Household Pulse Survey (HPS) Linked with HUD Administrative Data

Self-Reported Long COVID-19 Among HUD-Assisted Adults: Preliminary Findings from the Household Pulse Survey (HPS) Linked with HUD Administrative Data

Because nearly half of HUD-assisted adults have had COVID-19, it is important that HUD better understands the long-term impacts of a COVID diagnosis.

Veronica Helms Garrison and Barry Steffen

Highlights

• An estimated 46 percent of HUD-assisted adults reported that they had been previously told by a healthcare provider that they either had COVID-19 or had tested positive using a rapid point-of-care test, self-administered test, or laboratory test.
• Approximately 48 percent of HUD-assisted adults who reported a previous COVID diagnosis reported symptoms of long COVID.
• Approximately 21 percent of all HUD-assisted adults reported symptoms of long COVID regardless of the existence of a previous COVID-19 diagnosis or a confirmed positive test.

Introduction

Emerging evidence shows that some people can experience long-term adverse health effects after being infected with COVID-19. This condition, commonly referred to as long COVID, includes a range of ongoing symptoms that can last weeks, months, or longer. Notably, as of July 2021, long COVID is now considered a disability under the Americans with Disabilities Act. In response to this emerging public health threat, the U.S. Department of Health and Human Services is leading an interagency Long COVID Coordination Council in a whole-of-government effort to prevent, detect, and treat long COVID. (For more information about long COVID, see: Long COVID or Post-COVID Conditions | CDC).

Purpose

This article uses data from the U.S. Census Bureau’s Household Pulse Survey (HPS) linked with HUD administrative data on public and assisted housing programs to estimate the prevalence of self-reported long COVID among HUD-assisted adults.

Methods

HPS is an experimental, longitudinal survey designed to quickly capture information about the social and economic experiences of U.S. households during the COVID-19 pandemic. Along with several other topics related to abrupt and significant changes to American life, the HPS collects important information about housing circumstances and the associated impacts of the ongoing crisis.  To obtain the estimates presented in this article, HPS respondent information was linked with HUD administrative data at the individual and household level for the agency’s largest housing assistance programs. The U.S. Census Bureau reviewed all data products displayed in this article for unauthorized disclosure of confidential information and approved the disclosure avoidance practices applied to this release (CBDRB-FY23-POP001-0056). For more detailed information about the HPS-HUD data linkage, please contact Veronica.E.Helms@hud.gov.

Self-Reported COVID-19

In June 2022, PD&R analysts reported that between May 2021 and May 2022, an estimated 22.9 percent of HUD-assisted adults reported that a healthcare provider previously had informed them that they had COVID-19. In June 2022, however, the U.S. Census Bureau updated the HPS question about respondents’ COVID-19 diagnoses to include positive test results, including those for at-home tests. The revised question reads, “Have you ever tested (using a rapid point-of-care test, self-test, or laboratory test) positive for COVID-19 or been told by a doctor or other health care provider that you have or had COVID-19?”

Figure 1 underscores the finding that the previously reported COVID-19 diagnosis rate among HUD-assisted tenants was underreported. Among HUD-assisted adults responding to the updated question that includes at-home testing, from June 2022 to December 2022, an estimated 45.8 percent reported that a healthcare provider had previously told them that they had COVID-19 or that they had tested positive using a rapid point-of-care test, self-test, or laboratory test. This percentage is similar to that of the general U.S. adult population (48.2 percent), as shown in “Long COVID Content in the National Health Interview Survey and the Household Pulse Survey.” However, the Centers for Disease Control and Prevention (CDC) emphasizes that, even with the updated question, HPS estimates regarding self-reported COVID are still lower than other estimates based on seroprevalence studies. Because nearly half of HUD-assisted adults have had COVID-19, HUD needs to better understand the long-term impacts of a COVID diagnosis.

Figure 1: Data source is the Household Pulse Survey linked with HUD administrative data.

Long COVID Among HUD-Assisted Adults

Beginning in Phase 3.5 of the HPS (June 2022), the National Center for Health Statistics added survey questions designed to estimate the prevalence of long COVID. Additional questions about long COVID also were added in Phase 3.6 of the HPS (September 2022). As of January 2023, the HPS is in Phase 3.7. For more information about these changes, see: Long COVID: Household Pulse Survey — COVID-19 (cdc.gov).

Long COVID Among HUD-Assisted Adults Who Previously Had COVID-19

Figure 2 displays the percentage of HUD-assisted tenants reporting long COVID among those who reported a previous COVID-19 diagnosis or positive test. Approximately 48 percent of HUD-assisted adults who reported a previous COVID diagnosis reported symptoms of long COVID compared with approximately 30 percent of the general U.S. adult population.

Although figure 2 presents data by HUD program category, the reported rates are not statistically significant across HUD program categories, likely because of sample size limitations. As the U.S. Census Bureau continues to collect monthly HPS data, the agency can combine more data collection periods, and these estimates will become more stable. HUD analysts will continue to track self-reported long COVID among HUD-assisted adults to better understand these outcomes.  

Figure 2: Data collection for Weeks 46 to 52 occurred from June 2022 to December 2022.

Long COVID Among All HUD-Assisted Adults

Approximately 21 percent of all HUD-assisted adults report experiencing symptoms of long COVID regardless of a previous COVID-19 diagnosis or positive test. By comparison, national estimates using the same data source suggest that approximately 14 percent of the general U.S. adult population reported the same outcome.

Long COVID Among HUD-Assisted Adults by Characteristics

To better understand which characteristics are associated with long COVID among HUD-assisted tenants, we also examined self-reported long COVID (among those with a confirmed prior COVID diagnosis or positive test) by various characteristics. Many presented differences are not significant because of sample size limitations, but we hope to better understand these differences as we continue tracking self-reported long COVID among HUD-assisted adults.

Age Category

Figure 3 highlights self-reported cases of long COVID among HUD-assisted tenants by age category. Approximately 57 percent of HUD-assisted adults aged 18 to 40 reported having long COVID, the highest rate among HUD-assisted adults. Older HUD-assisted adults reported lower rates of long COVID, with approximately 36 percent of those aged 62 and older reporting long COVID symptoms. This finding is consistent with CDC research using HPS data that found that older adults are less likely than younger age groups to report long COVID symptoms. For more information about this phenomenon, see: Nearly One in Five American Adults Who Have Had COVID-19 Still Have "Long COVID" (cdc.gov).

Race and Ethnicity

Preliminary findings suggest that, among HUD-assisted adults, no significant differences exist in the prevalence of long COVID on the basis of race category (White, Black, Asian, other) or ethnicity status (Hispanic or non-Hispanic). However, more data is needed to better understand these relationships.

Presence of Children in the Household

Figure 4 highlights self-reported cases of long COVID among HUD-assisted tenants by the presence of children in the household. According to preliminary findings, more than half (approximately 68 percent) of HUD-assisted families with children report experiencing long COVID symptoms compared with approximately 32 percent of HUD-assisted families without children.

Conclusion

As presented above, preliminary findings suggest that relatively high rates of HUD-assisted adults report experiencing long COVID symptoms. Specifically, among HUD-assisted adults, those aged 18 to 40 and those living in households with children reported the highest rates of long COVID. The presented research represents the start of an ongoing effort to track and understand symptoms of long COVID among HUD-assisted households. In addition, the U.S. Department of Health and Human Services added more questions about long COVID to Phase 3.6 of the HPS (September 2022). HUD will continue to examine these results, including new questions that assess whether people who report ever having symptoms continue to experience symptoms. In addition, new questions have emerged regarding the impact of long COVID on day-to-day activities; these questions will be an important construct for assessing disability status among HUD-assisted individuals.