Social Determinants of Health and Long‑Term Joblessness Among Severe COVID‑19 Survivors: Secondary Analysis of a Nationwide 2‑Year Prospective Cohort (COVID-19 Recovery Study II)
Year: 2026
Type: article
Abstract: OBJECTIVE: Return-to-work varies among previously employed patients after critical illness. Social determinants of health (SDH) may play a role in this variation. We compared patient characteristics and explored the association between SDH and long-term joblessness among patients who experienced severe COVID-19. DESIGN: A secondary analysis of a prospective nationwide database. SETTINGS: The COVID-19 Recovery Study II (CORES II) study, a nationwide prospective observational study in Japan that examined long-term symptoms and social status over two years following hospitalization. PATIENTS: We included adults hospitalized with severe COVID-19 between April 1 and September 30, 2021, who were employed before hospitalization. SDH included education history and pre-hospitalization employment status. MEASUREMENTS AND MAIN RESULTS: The primary outcome was joblessness at the first- and second-year follow-ups. We used generalized estimating equations for the main analysis to examine longitudinal associations between SDH and joblessness, with the SDH variables entered into the model as separate categorical variables.Of 3297 hospitalized patients, 337 met inclusion criteria. At the first-year follow-up, 275 had returned to work, whereas 62 (18.4%) remained jobless. At the second-year follow-up, 242 (82.3 %) had returned to work, and 52 (17.7%) remained jobless. Patients who were jobless at the first-year follow-up showed more persistent symptoms and greater physical and mental impairment compared with those who returned to work. Among SDH factors, non-permanent employment was associated with joblessness over the 2-year follow-up period (odds ratio 2.35; 95% CI [1.26-4.40]) compared with permanent employment. Education history was not associated with joblessness at the first- or second-year follow-ups. CONCLUSIONS: Non-permanent employment was associated with joblessness during the pandemic after hospitalization for severe COVID-19. Pre-hospitalization employment status may be relevant to long-term social recovery after critical illness.
Source: Critical Care Explorations
Authors: Akira Kawauchi, Mitsunobu Nakamura, Shuhei Maruyama, Shinichiro Morioka, Katsuji Teruya, Takeshi Nishida, Toshiyuki Harada, Hideki Yoshida, Satoshi Miike, Hideaki Kato, Junji Hatakeyama, Shigeki Fujitani, Tomohiro Asahi, Kensuke Nakamura, Yuichi Sato, Taku Oshima, Futoshi Nagashima, Kohei Ota, Tatsuya Fuchigami, Nobuyuki Nosaka, Hiroshi Kamijo, Takeshi Hattori, Hayato Taniguchi, Katrina Hauschildt, Snigdha Jain, Arisa Iba, Miyuki Hori, Yoko Muto, Mariko Hosozawa, Hiroyasu Iso, On behalf of the COVID-19 Recovery Study II (CORES II) Study Group.
Institutions: Maebashi Red Cross Hospital, Aso Iizuka Hospital, Kansai Medical University, Kansai Medical University Medical Center, National Center for Global Health and Medicine, Japan Institute for Health Security, Osaka Prefectural Medical Center, Hokkaido hospital, Japan Community Healthcare Organization, Yokohama City Seibu Hospital, Yokohama City University Hospital, Osaka Medical and Pharmaceutical University, St. Marianna University School of Medicine, Naha City Hospital, Hitachi General Hospital, Tokyo Metropolitan Tama Medical Center, Chiba University, Toyooka Hospital, Hiroshima University Hospital, University of the Ryukyus, University of the Ryukyus University Hospital, Institute of Science Tokyo, Shinshu University, National Hospital Organization Hokkaido Medical Center, Yokohama City University Medical Center, Johns Hopkins University, Yale University
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,600
OpenAlex ID: W7169867187