An international team of researchers has conducted the most comprehensive global-to-local analysis to date on long COVID risk, using disability data from the height of the pandemic to identify vulnerable populations. Drawing on the Global Burden of Disease (GBD) 2021 framework, the study examined years lived with disability (YLDs) caused by COVID-19 across 920 locations during 2020 and 2021. The results reveal that YLDs may serve as an early indicator of long COVID risk—particularly in areas where post-COVID conditions remain underreported.
"Disability-related data may serve as an early warning indicator for long COVID," said Dan Shan, co-first author of the study. "We found that many communities, especially in low-resource settings, were already experiencing a disproportionately high burden of prolonged symptoms. Without intervention, this might translate into years of long COVID consequences that go largely untracked."
The study uncovered alarming disparities. In 2021, eight of the top ten countries with the highest age-standardized YLD rates were low-, lower-middle-, or middle-income nations, such as Mozambique, Malawi, Ethiopia, and Iraq. These locations often lack robust health systems, making it harder to diagnose, report, and manage post-acute COVID conditions. In addition, women aged 20 and above were found to bear a significantly higher burden than men, consistent with trends reported in other long COVID research.
While wealthier countries often had lower overall YLD rates, the researchers found large inequalities within them. In the United States, for example, potential long COVID risk varied widely across states, with rural and underserved areas showing higher YLD rates. This pattern suggests that national averages could obscure important local vulnerabilities—something the authors say should be addressed in future public health strategies.
"Even within high-income nations, we saw dramatic differences between communities," said Shan. "The effects of long COVID are not equally distributed, and without granular data, certain subgroups may be overlooked in policy decisions."
The researchers call for urgent expansion of long COVID care, especially in lower-resource settings, and for the integration of disability data into early warning systems. They also urge global health agencies to prioritize vulnerable groups for rehabilitation services, research funding, and surveillance infrastructure. "Ignoring these warning signs risks deepening global health inequalities for years to come," Shan suggested.
