Long Covid in ethnic minority populations: ? Lost in translation

The paper discusses long COVID (post-acute COVID-19 syndrome), noting disproportionate impacts of COVID-19 on elderly individuals, those with comorbidities, socioeconomically deprived populations, and ethnic minorities. It highlights that evidence on long COVID prevalence and symptom profiles in ethnic minority groups is inconsistent, with some studies indicating higher prevalence and others lower. The authors emphasize gaps in data, particularly from low- and middle-income countries, and raise the central issue that cultural, linguistic, health literacy, and healthcare interaction factors may affect how symptoms are experienced, reported, recorded, and interpreted in ethnic minority populations.

The article synthesizes findings from multiple studies: (1) A UK analysis of 10 longitudinal studies reported significantly lower odds of long COVID (>4 weeks) in South Asian and Black populations compared with White groups. (2) A Danish nationwide cohort suggested higher risk of long COVID among ethnic minorities from North Africa, the Middle East, Eastern Europe, and Asia versus native Danes. (3) US studies reported differing post-acute sequelae by race/ethnicity: Black patients more often had thromboembolism, cough, diabetes, chest pain, and acute injury; White patients more often had sleep disorders and GERD. In another US EHR-based cohort (31–180 days post-diagnosis), hospitalized Black patients had higher odds of diabetes and headaches; hospitalized Hispanic patients had higher odds of headaches and dyspnoea; among non-hospitalized, Black patients had higher odds of pulmonary embolism and diabetes, and Hispanic patients had higher odds of headaches or chest pain. Another study found higher long COVID likelihood in ethnic minorities, with differing cognitive symptoms (Blacks more likely to report memory trouble; Hispanics more likely difficulty understanding). The paper also reviews literature on ethnic differences in symptom reporting and acculturation effects: South Asians in the UK reported higher musculoskeletal pain prevalence (with heterogeneity among Indian, Pakistani, Bangladeshi groups) and partial mediation by acculturation; Asians in the US reported fewer general physical symptoms than Whites, with differences attenuating when language was accounted for; Latino and White groups showed similar symptom prevalence, while Asian Americans reported fewer physical symptoms, with acculturation associated with symptoms in Latino and Asian groups. Underreporting of depression and higher pain prevalence in ethnic minorities are noted, potentially due to communication barriers, health-seeking behavior, and concerns about stereotyping. A UK consultation-based study found increased long COVID risk in Black Afro-Caribbean and Mixed groups, with Asian individuals presenting broader symptom spectrums (pain, fatigue, rashes). The authors further discuss challenges in using validated symptom questionnaires across cultures, highlighting limitations of forward–back translation and the need for culturally adapted, linguistically appropriate patient-reported outcome measures developed with input from translators and focus groups.

• Evidence on long COVID prevalence and symptom burden in ethnic minority populations is mixed across studies and settings, with some reporting lower odds (e.g., UK longitudinal analyses) and others higher risks (e.g., Danish nationwide cohort).
• Symptom profiles and post-acute sequelae differ by race/ethnicity in several US cohorts: Black patients show higher odds of thromboembolism, diabetes, chest pain, pulmonary embolism, and headaches; Hispanic patients have higher odds of headaches, dyspnoea, and chest pain; White patients more often report sleep disorders and GERD; cognitive symptom patterns also vary (e.g., memory vs understanding difficulties).
• Variations likely reflect a combination of factors: cultural and sociodemographic influences on symptom expression, communication barriers, health literacy, clinician interpretation, thresholds for reporting, psychological distress, and possible biological differences.
• Prior literature shows substantial inter-ethnic and within-group heterogeneity in symptom reporting (e.g., musculoskeletal pain among South Asians) and roles for acculturation and language in shaping reported symptoms.
• Routine electronic health record studies may inadequately capture cultural nuances; validated questionnaires may not be culturally adapted, risking misclassification or under-ascertainment in minority groups.
• There is a paucity of data from low- and middle-income countries, limiting generalizability and cross-country comparisons.

The findings underscore that current estimates of long COVID prevalence and symptomatology in ethnic minority populations may be biased by cultural, linguistic, and healthcare system factors that influence how symptoms are reported and recorded. Discrepancies between studies (e.g., UK vs Danish vs US cohorts) suggest that context, measurement approaches, and population composition critically affect observed disparities. The paper argues that translation—both linguistic and cultural—of patient-reported outcomes is central to accurate assessment. Without culturally adapted instruments and inclusive study designs, research risks underrepresenting the true burden and distinct symptom patterns in ethnic minorities, potentially perpetuating disparities in diagnosis, care access, and outcomes.

Long COVID research in ethnic minority populations shows inconsistent results and indicates differences in symptom experiences compared with White populations. To avoid misinterpretation and inequities, future work should prioritize: (1) comprehensive, inclusive studies examining prevalence, risk factors, and mechanisms in ethnic minority and other underserved groups; (2) culturally and linguistically adapted, validated patient-reported outcome measures developed with community input; (3) routine incorporation of comprehensive PRO assessments in clinical care and research; and (4) active partnership with underserved communities to build trust and ensure measurement of outcomes that matter to them. Advancing these areas will help prevent widening disparities and improve translation of long COVID research into equitable care.

• Limited primary data specific to ethnic minority populations, with most evidence derived from high-income countries and routine databases that may not capture cultural nuances.
• Inconsistent operational definitions and measurement tools for long COVID across studies, including lack of culturally adapted and validated questionnaires.
• Potential biases due to language barriers, health literacy differences, healthcare access/consultation patterns, and clinician interpretation, which may affect both symptom reporting and ascertainment.
• Heterogeneity within broad ethnic categories (e.g., South Asian subgroups) complicates generalizability.
• As a narrative/commentary piece, the paper does not present original empirical data or formal systematic methods, limiting causal inference.