Abstract
Introduction:
Long COVID (LC) is associated with significantly more days of work missed due to illness. Given this impact on the workforce, we estimated the lost labor costs associated with these additional missed workdays among individuals with LC in the US in 2022.
Methods:
104,889,622 (weighted) adult full-time workers in the 2022 Medical Expenditure Panel Survey were categorized as: never had COVID-19, had COVID-19 without LC, and had LC. The estimated cost of lost labor from days of work missed due to illness/injury in 2022 was calculated as: (hours worked per week ÷ 5) × (hourly wage) × (days of work missed). Differences in mean costs were assessed using one-way ANOVA. The population-level lost labor cost associated with LC was estimated as (mean lost labor cost for LC − mean lost labor cost for never had COVID-19) × (number of full-time workers ≥18 years in the US in 2022 × prevalence of LC in the study population).
Results:
The total estimated lost labor cost from days of work missed due to illness/injury for individuals with LC was $15,863,994,281 (SE, $1,748,160,632). The mean lost labor cost for individuals with LC was more than twice that of individuals who never had COVID-19 and significantly higher than those who had COVID-19 without LC. The population-level lost labor cost associated with LC was estimated to be $12,784,168,675.20 (SE, $1,946,074,821.60).
Discussion:
These findings highlight the substantial economic impact of LC, totaling more than $12 billion in lost labor costs in 2022, emphasizing the need for targeted prevention and treatment strategies.
Keywords: Absenteeism, Analysis of Variance, Cost of Illness, COVID-19, Health Care Economics, Long COVID, Occupational Health, Pandemics, Population Health, Workforce
Introduction
Recent evidence has shown that individuals with long COVID (LC) have a higher rate of missing work in a year than individuals who had COVID-19 without LC or those who did not have COVID-19.1 Given this significant impact on the workforce, we sought to estimate the real-world lost labor costs associated with these additional missed workdays among individuals with LC in the US in 2022.
Methods
The study population comprised adult (≥18 years) respondents to the 2022 Medical Expenditure Panel Survey (MEPS) who worked 35 to 100 hours per week, with available data concerning COVID-19 and LC history, hours worked per week, hourly wage, and number of days of work missed due to illness/injury in 2022. The total sample size was 104,889,622 (weighted). Individuals were categorized into 3 groups: never had COVID-19, had COVID-19 without LC, and had LC (defined as ever having had COVID-19 symptoms lasting 3 months or more).
The estimated cost of lost labor per individual from days of work missed due to illness/injury in 2022 was calculated as: (hours worked per week ÷ 5) × (hourly wage) × (days of work missed due to illness/injury). This formula follows the human capital approach, which is commonly used in cost-of-illness analyses to estimate productivity losses by multiplying the number of working hours lost due to illness by the gross hourly wage.2–3
Differences in mean lost labor costs among the 3 groups were assessed using an unadjusted one-way ANOVA, followed by Tukey-Kramer post hoc pairwise comparisons adjusted for multiple comparisons.
A population-level estimate for the US of the lost labor cost associated with LC in 2022 was extrapolated from this using a person-based (“bottom-up”) method, which scales individual-level estimates to the population using appropriate prevalence data.4 Specifically, the estimate was calculated as: difference in mean lost labor cost between those with LC and those who never had COVID-19 × (number of full-time workers aged ≥18 years in the US in 2022 × prevalence of LC in the study population). According to the Bureau of Labor Statistics, there were 131,960,000 full-time workers aged ≥18 years in the US in 2022.5
We used the difference in mean lost labor cost between those with LC and those who never had COVID-19 to estimate the population-level cost attributable to LC, as this approach isolates the incremental burden specifically associated with LC while accounting for baseline levels of work absence present in the general population without LC. This provides a more precise and conservative estimate than simply multiplying the mean per-person cost in the LC group by the overall population count of full-time workers in the US.
In addition, an unadjusted survey-weighted logistic regression model was fitted to examine whether having paid sick leave (yes vs no) was associated with the odds of having LC (yes vs no). All analyses accounted for the MEPS complex survey design, using person-level weights along with strata and cluster variables to account for probability of selection, nonresponse, and to reflect US population totals, enabling nationally representative estimates; further details on MEPS design and weighting are available on the Agency for Healthcare Research and Quality (AHRQ) website.6 Analyses were conducted using SAS version 9.4, with statistical significance defined as P < .05 (two-sided). This research was exempt from IRB review by the authors’ institution.
Results
In the study population, the weighted prevalence of LC was 7.8% (SE, 0.4%). Overall, 81.2% (SE, 0.7%) had paid sick leave, including 79.6% (SE, 2.5%) of those with LC.
The total estimated lost labor cost from days of work missed due to illness/injury for individuals with LC was $15,863,994,281 (SE, $1,748,160,632). For those who never had COVID-19, and for those who had COVID-19 without LC, the total costs were $31,016,098,164 (SE, $2,512,694,954) and $77,051,513,328 (SE, $6157,252,808), respectively.
The total cost was lowest for the LC group because it had the fewest individuals. However, the mean lost labor cost per individual was more than twice as high in the LC group ($1,944.46 [SE, $178.04]) compared with those who never had COVID-19 ($702.42 [SE, $47.98]) (Table 1). The mean cost was also significantly higher among individuals with LC than those who had COVID-19 without LC ($1,465.55 [SE, $91.28]). Table 2 presents the differences in the weighted mean lost labor costs among the 3 groups.
Table 1.
Estimated Lost Labor Costs from Days of Work Missed Due to Illness/Injury in 2022 Stratified by COVID-19 and Long COVID History
| Group (Sample Size, Weighted) | Total Cost (SE) | Mean Cost (SE) | Median Cost (SE) | IQR Cost (SE) |
|---|---|---|---|---|
| Never had COVID-19 (n = 44,156,049) | 15,863,994,281 (1,748,160,632) | 702.42 (47.98) | 0 (35.21) | 478.47 (55.53) |
| Had COVID-19 without long COVID (n = 52,575,022) | 1,016,098,164 (2,512,694,954) | 1,465.55 (91.28) | 461.60 (35.15) | 1,520.00 (77.54) |
| Had long COVID (n = 8,158,551) | 15,863,994,281 (1,748,160,632) | 1,944.46 (178.04) | 777.67 (105.24) | 2,308.96 (252.73) |
Costs are reported in USD. Weighted total costs, means, medians, and interquartile ranges (IQRs) are presented with standard errors (SE).
Table 2.
Differences in Weighted Mean Lost Labor Costs from Days of Work Missed Due to Illness/Injury in 2022 Between COVID-19 and Long COVID Groups
| Post-Hoc Comparison (Tukey-Kramer) | Difference in Mean Cost (SE) | Adjusted* P-value |
|---|---|---|
| Had long COVID versus never had COVID-19 | 1,242.04 (189.07) | <0.0001 |
| Had COVID-19 without long COVID versus never had COVID-19 | 763.13 (100.28) | <0.0001 |
| Had long COVID versus had COVID-19 without long COVID | 478.91 (202.06) | 0.0485 |
Costs are reported in USD. Differences in weighted mean costs are presented with standard errors (SE).
*Adjusted P-values are from Tukey-Kramer post-hoc pairwise comparisons, which apply a multiple comparison adjustment; no covariates were included in these analyses.
The population-level estimate of the total lost labor cost associated with LC in 2022 was $12,784,168,675.20 (SE $1,946,074,821.60).
The results of the logistic regression model showed no significant association between having paid sick leave and having LC (OR = 0.90, 95% CI: 0.66 to 1.23, P = .51).
Discussion
Previous studies have illustrated the morbidity, mortality, and health care costs associated with LC.7–9 This study contributes novel information by providing real-world estimates of lost labor costs due to LC, based on observed missed workdays. A prior modeling study estimated that LC had cost US employers $1.99–$6.49 billion in productivity losses as of early 2024.10 The present results indicate the real-world cost of LC on lost labor far exceeds this, amounting to more than $12 billion in 2022 alone based on the population-level estimate. Given that most individuals had paid sick leave, most of these costs were likely borne by employers. In addition, paid sick leave was not associated with the odds of having LC.
The study’s strengths included the use of nationally representative data, and the weighted prevalence of LC (7.8%) in the study population approximated that in other studies, supporting its external validity.1,11 Limitations included the reliance on self-reported data for COVID-19 and LC history and days of work missed, which may have led to underestimation or overestimation of the true economic impact, as well as the lack of direct measures for sick days specifically attributable to LC; however, LC’s clinical sequelae are quite varied.9
These findings highlight the substantial economic burden of LC on the nation and its workforce. In the absence of effective treatments, these consequences underscore the need to prioritize prevention through vaccination − the best available strategy to reduce the risk of LC − and accelerate research into effective therapies.
Footnotes
This article was externally peer reviewed.
Funding: None.
Conflict of interest: None.
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