Post-COVID-19 condition and disparities in daily functional activities in England: a retrospective analysis of data from the Virus Watch community cohort

Background: Post-COVID-19 condition is increasingly recognised to impair daily functioning. In the UK and many other settings worldwide, primary care is the first point of contact and key provider of care for people with the condition. Consequently, identifying groups at heightened risk allows primary care services to tailor assessment, support, and referral pathways more effectively. This analysis aims to investigate the role of socioeconomic deprivation, migration status, and ethnicity in experiencing limitations in six functional activities. Methods: We used data from Virus Watch, a prospective community cohort study in England and Wales, which enrolled 58 628 participants between June 22, 2020, and March 31, 2025. Participants self-reported new persistent symptoms and their effects on six functional activities (work or education, concentration, self-care, care for others, performance of necessary activities outside the house, and engagement in enjoyable activities) through six surveys over 4 years (2021-24). In this retrospective analysis, participants were included if they (1) were aged 18 years or older and lived in England; (2) were successfully linked to national hospitalisation, COVID-19 testing and vaccination, and mortality data; (3) were not admitted to hospital for or with COVID-19; and (4) self-reported persistent symptoms that met the WHO consensus definition of post-COVID-19 condition. Logistic regression was used to assess how deprivation level, migration status, and ethnic minority status were associated with the odds of experiencing each functional limitation, adjusting for sociodemographic variables. Findings: 776 individuals with post-COVID-19 condition were included in this analysis (552 [71%] female, 224 [29%] male; 685 [88%] White British, 88 [11%] ethnic minority, and 11 [1%] missing ethnicity). 686 (88%) reported experiencing limitations in at least one daily activity. Individuals with post-COVID-19 condition in Index of Multiple Deprivation quintile (IMD) 1 (the most deprived quintile) had higher adjusted odds of limitations in work or education (adjusted odds ratio [aOR]; 2·30 [95% CI 1·12-4·93]), concentration (2·78 [1·42-5·81]), self-care (2·11 [1·06-4·16]), and doing necessary activities outside the house (2·06 [1·12-3·90]) than those in IMD 5 (the least deprived). Those in IMD 2 also experienced increased odds of limitations in work or education (1·90 [1·09-3·34]) and concentration (1·91 [1·17-3·14]) compared to those in IMD 5. We found no evidence of associations between migration status or minority ethnicity status with functional limitations (migration status aOR range from 0·67 [0·25-1·73] to 1·52 [0·64-3·77]; minority ethnicity status aOR range from 0·66 [0·35-1·17] to 1·41 [0·82-2·53]). Interpretation: Socioeconomic deprivation, rather than migration status or ethnicity, primarily drives functional limitations within this cohort of individuals with post-COVID-19 condition. Functional limitations might perpetuate cycles of deprivation and further exacerbate health inequalities. Equitable access to primary care and rehabilitation and support services, alongside workplace and educational adaptations, is needed to address the functional limitations of those affected by post-COVID-19 condition. Similar strategies might also be used to support individuals with long-term functional impairment following other post-acute infection syndromes. Funding: Medical Research Council, Wellcome Trust, and European Union.