Racial Disparities in Long COVID: Why Black Americans are Likely Underrepresented in Long COVID Estimates.

In this conceptual paper, we posit that Black Americans are likely underrepresented in current Long COVID data estimates and explore potential reasons for this underrepresentation, with the purpose of beginning a critical dialogue within the Long COVID research community on this topic. Throughout the COVID-19 pandemic, Black individuals were 10% more likely to acquire SARS-CoV-2 and twice as likely to be hospitalized with COVID-19 than White individuals, increasing their risk for Long COVID. Nevertheless, studies based on national surveys and electronic health records often report lower Long COVID prevalence estimates for Black vs. White populations. Factors contributing to this discrepancy may include lack of Long COVID awareness, limited generalizability of existing studies, barriers to diagnosis, and medical racism and mistrust. Addressing these issues requires a comprehensive approach that includes creating targeted Long COVID awareness campaigns, updating the mode and breadth of data collection activities, reducing diagnostic barriers, and ultimately tackling the systemic racism that underlies these health inequities. Accurate representation in data is essential for understanding the full impact of Long COVID and developing interventions that are equitable and effective.