{ "abstract": "Background: Long COVID has emerged as a major public health concern in the United States, yet geographic variation in its prevalence remains poorly understood. This study examines how state-level differences in COVID-19 vaccination, SARS-CoV-2 infection burden, severity of acute COVID-19 (measured by hospitalization rates) and multimorbidity burden relate to adult Long COVID prevalence in the United States. Methods: We conducted an ecological analysis using data from the 2023 Behavioral Risk Factor Surveillance System (BRFSS), from which we estimated state-level prevalence of self-reported Long COVID among adults. These estimates were linked with publicly available data on SARS-CoV-2 incidence, COVID-19 hospitalizations, COVID-19 vaccine coverage, and a multimorbidity indicator (defined as ≥3 chronic conditions associated with increased risk of severe COVID-19, e.g., diabetes, obesity, chronic kidney disease). Multivariable linear regression models were used to assess the association between these factors and Long COVID prevalence, adjusting for state age and sex distributions. Rubin’s rules were applied to propagate the uncertainty in the estimates of Long COVID and COVID-19 vaccine coverage through regression analyses. Results: All examined factors—including SARS-CoV-2 incidence, COVID-19 hospitalization, COVID-19 vaccine coverage, and multimorbidity prevalence—varied by state. In univariable analyses, vaccine coverage and multimorbidity prevalence were significantly associated with Long COVID prevalence. In the multivariable model, vaccine coverage and SARS-CoV-2 incidence were significant; however, after accounting for uncertainty in Long COVID and vaccine coverage estimates, only higher vaccine coverage remained significantly associated with lower Long COVID prevalence. Conclusions: Higher State-level variation in COVID-19 vaccine coverage was consistently associated with lower adult Long COVID prevalence. These ecological findings support further investigation of vaccination and other state-level determinants of Long COVID burden and may inform population-level strategies for addressing Long COVID.", "abstract_shown": true, "affiliations": [ "Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America" ], "article_type": "Research Article", "arxiv": null, "author_total": 4, "authors": [ { "affs": [ 0 ], "name": "Xinmeng Zhao", "orcid": "0000-0002-2711-2091" }, { "affs": [ 0 ], "name": "Li Deng" }, { "affs": [ 0 ], "name": "Nicole D. Ford", "orcid": "0000-0002-6463-5094" }, { "affs": [ 0 ], "name": "Sharon Saydah", "orcid": "0000-0002-6350-5300" } ], "bibtex": "https://research.draconitic.com/paper/7nvht32kqybyj.bib", "cited_by": 0, "doi": "10.1371/journal.pone.0345433", "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13730352/", "id": "7nvht32kqybyj", "issns": [ "1932-6203" ], "landing_url": "https://doi.org/10.1371/journal.pone.0345433", "language": "en", "licence": "CC0-1.0", "licence_label": "CC0", "licence_source": "article", "licence_url": "https://creativecommons.org/publicdomain/zero/1.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Biology and Life Sciences" ], [ "heading", "Biology and life sciences" ], [ "heading", "Booster Doses" ], [ "heading", "Coronaviruses" ], [ "heading", "Covid 19" ], [ "heading", "Epidemiology" ], [ "heading", "HIV vaccines" ], [ "heading", "Immunology" ], [ "heading", "Infectious Disease Control" ], [ "heading", "Infectious Diseases" ], [ "heading", "Infectious disease control" ], [ "heading", "Infectious diseases" ], [ "heading", "Medical Conditions" ], [ "heading", "Medical Risk Factors" ], [ "heading", "Medical conditions" ], [ "heading", "Medical microbiology" ], [ "heading", "Medicine and Health Sciences" ], [ "heading", "Medicine and health sciences" ], [ "heading", "Microbial pathogens" ], [ "heading", "Microbiology" ], [ "heading", "Organisms" ], [ "heading", "Pathogens" ], [ "heading", "Pathology and laboratory medicine" ], [ "heading", "Preventive Medicine" ], [ "heading", "Public and Occupational Health" ], [ "heading", "RNA viruses" ], [ "heading", "Research Article" ], [ "heading", "SARS CoV 2" ], [ "heading", "SARS coronavirus" ], [ "heading", "Vaccination and Immunization" ], [ "heading", "Vaccines" ], [ "heading", "Viral Diseases" ], [ "heading", "Viral pathogens" ], [ "heading", "Viral vaccines" ], [ "heading", "Virology" ], [ "heading", "Viruses" ], [ "plos", "/Biology and life sciences/Immunology/Vaccination and immunization" ], [ "plos", "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Coronaviruses/SARS coronavirus/SARS CoV 2" ], [ "plos", "/Biology and life sciences/Microbiology/Virology/Viral vaccines/HIV vaccines" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/RNA viruses/Coronaviruses/SARS coronavirus/SARS CoV 2" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Coronaviruses/SARS coronavirus/SARS CoV 2" ], [ "plos", "/Medicine and health sciences/Epidemiology" ], [ "plos", "/Medicine and health sciences/Epidemiology/Medical risk factors" ], [ "plos", "/Medicine and health sciences/Immunology/Vaccination and immunization" ], [ "plos", "/Medicine and health sciences/Medical conditions/Infectious diseases/Infectious disease control/Vaccines" ], [ "plos", "/Medicine and health sciences/Medical conditions/Infectious diseases/Infectious disease control/Vaccines/Booster doses" ], [ "plos", "/Medicine and health sciences/Medical conditions/Infectious diseases/Infectious disease control/Vaccines/Viral vaccines/HIV vaccines" ], [ "plos", "/Medicine and health sciences/Medical conditions/Infectious diseases/Viral diseases/COVID 19" ], [ "plos", "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Coronaviruses/SARS coronavirus/SARS CoV 2" ], [ "plos", "/Medicine and health sciences/Public and occupational health/Preventive medicine/Vaccination and immunization" ] ], "openalex": null, "pdf_url": null, "pmcid": "PMC13730352", "pmid": "42976189", "published": "2026-11-03", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/7nvht32kqybyj.ris", "sources": [ { "first_seen": "2026-11-04T12:20:43Z", "native_id": "10.1371/journal.pone.0345433", "source": "plos", "url": "https://doi.org/10.1371/journal.pone.0345433" }, { "first_seen": "2026-11-07T12:22:55Z", "native_id": "PMC13730352", "source": "pmc", "url": "https://doi.org/10.1371/journal.pone.0345433" } ], "subjects": [ { "field": "biology", "origin": "plos:immunology", "subfield": "immunology" }, { "field": "biology", "origin": "heading:Microbiology", "subfield": "microbiology" }, { "field": "medicine", "origin": "plos:epidemiology", "subfield": "epidemiology-public-health" }, { "field": "medicine", "origin": "plos:infectious diseases", "subfield": "infectious-disease" } ], "title": "Long COVID prevalence among U.S. adults: A state-level ecological analysis of associations with SARS-CoV-2 incidence, COVID-19 hospitalization rates, COVID-19 vaccine coverage, and multimorbidity", "title_text": "Long COVID prevalence among U.S. adults: A state-level ecological analysis of associations with SARS-CoV-2 incidence, COVID-19 hospitalization rates, COVID-19 vaccine coverage, and multimorbidity", "type": "peer-reviewed", "updated_at": "2026-11-07T12:22:55Z", "url": "https://research.draconitic.com/paper/7nvht32kqybyj", "venue": "PLOS One", "versions": [] }