Geographic Disparities and Emerging Hotspot Trends of Long COVID in the United States, 2025, Gourishankar

[forestglip]

Geographic Disparities and Emerging Hotspot Trends of Long COVID in the United States

Anand Gourishankar

Objectives
To study the emerging hotspot pattern of Long COVID (LC) in the U.S. population and investigate the correlation between Long COVID and state health system performance.

Methods
Using 2022 to 2024 Center for Disease Control and Prevention adult LC data, I applied the Getis-Ord Gi* statistic with the Mann-Kendall trend test to determine emerging temporal trends associated with local clustering patterns across the contiguous states. A Pearson's correlation tested LC rates and state health system performance.

Results
A spatiotemporal trend map described discrete patterns. In 2023, Long COVID rates were highest in Southeastern states such as Mississippi and West Virginia, but by 2024, mixed patterns were observed in some states. The LC rates showed an inverse relationship with state health outcome scores (r = -0.69, P < 0.001). Emerging hotspot analysis identified Mississippi as a persistent hotspot for Long COVID. Northeastern states showed consistently persistent cold spots.

Conclusions
The states with better health outcomes showed a lower frequency of long COVID. The geographically emerging hot spots can guide focused intervention and resource allocation for these patients.

Link (The American Journal of the Medical Sciences) [Paywall]

 

[Murph]

I'm keen on this kind of basic epidemiology, I have suspicions that populations are not equally prone to me/cfs even after controlling for pre-existing health outcomes.

I have been prone to thinking of me/cfs as a disease mostly of the north sea populations and their diaspora (my forebears included). Perhaps that's just selection bias, but I can't quite rid myself of the impression the focus on me/cfs is located along the top of Europe vis-a-vis the interior or the mediterranean coast. Why Bergen and Norwich, not Vienna and Rome? also, Utah has an unusually large English heritage compared to other states in the western USA and it's where some mecfs research is located.

THis research would appear on its face to be an argument against that but among white people Mississpi is higher in English heritage than some other states.


This is all mere vibes, but it's not vibes vs hard science, there's nobody on the other side of the net to return the shot; not enough data exists to do good science here.

 

[forestglip]

State comparisons in the United States - Statistics & Facts

Mississippi is lowest out of 50 states plus District of Columbia for:

• Real per capita gross domestic product, 2023
• Median household income, 2023

West Virginia is 2nd and 3rd to last for these two stats, respectively.

 

[forestglip]

According to the Covid States Project, out of 50 states plus D.C., Mississipi had the 6th highest rate of unvaccinated people (had not received any COVID vaccines by January 4, 2023). West Virginia had the 8th highest rate.

 

[forestglip]

CDC: Adult Obesity Prevalence Maps

Out of 52 states and territories, Mississippi had the 2nd highest obesity rate in 2023, and West Virginia the highest.

BMI has come up a few times as a risk factor for long COVID:

Post Acute Sequelae from SARS-CoV-2 (PASC) at University of Illinois Hospital and Clinics – An Examination of the Effects of Long COVID in an Underserved Population, Utilizing Manual Extraction of Electronic Health Records (2025, American Journal of Medicine Open)

Prevalence and Determinants of Long-Term Post-COVID Conditions in the United States: 2022 Behavioral Risk Factor Surveillance System (2024, American Journal of Medicine)

Association of vaccine status, reinfections, and risk factors with Long COVID syndrome (2024, Nature Scientific Reports)

 

[Hutan]

An issue when considering where people might be more vulnerable to Long Covid is the fact that the frequency of the triggering Covid-19 infections will vary in different places and among different groups of people. If people in one place are having more Covid-19 infections, they will probably have more Long Covid. I think Mississippi has been hit with a lot of Covid-19.

The other thing is that Long Covid is not a synonym for ME/CFS. Mississippi has had one of the highest Covid-19 death rates. It stands to reason that it has also had a lot of people with severe Covid-19 infections, perhaps due to co-morbidities, perhaps due to poor medical care. Therefore, among the survivors there will be a lot of people with damage arising from their severe infection. That may be counted as Long Covid, but it's not ME/CFS.

I think you have to somehow stratify Long Covid into more useful categories and understand the frequency of exposure to Covid-19 before this sort of epidemiology gives you clean-ish data to think about ME/CFS.

@Murph - interesting map. I'm surprised at the level of German ancestry in so many of the US states.

 

[Hutan]

Why Bergen and Norwich, not Vienna and Rome? also, Utah has an unusually large English heritage compared to other states in the western USA and it's where some mecfs research is located.

Oh, and Vienna is actually becoming a leader in ME/CFS research.

I am certainly intrigued by the idea that there might be populations where ME/CFS is less prevalent and would like to see studies investigating that. But I don't think we have seen any good evidence that that idea is true. That's one of the things that is quite clear from our regional news threads - ME/CFS seems to occur in all sorts of countries.

 

[Creekside]

One big problem is that incidence of ME and reporting of ME might be wildly different in different locales. The likelihood of getting an official diagnosis of ME would vary too; imagine one PWME going to doctors all around the world (posing as a local) and describing the symptoms.