Temporal, Demographic, and Geographic Patterns of Long COVID Incidence in Relation to SARS-CoV-2 Variant Emergence: Insights from the Texas All-Payer Claims Database (TX-APCD).

OBJECTIVES: Long COVID, defined by symptoms persisting or emerging after the acute SARS-CoV-2 phase, poses a growing public health challenge. METHODS: Using the Texas All-Payer Claims Database (TX-APCD), covering approximately 60% of insured Texans from October 2021 to October 2023, we examined associations between COVID-19 emergency department (ED) visits and Long COVID claims across variant periods. Individual-level time to first Long COVID diagnosis was modeled comparing ED and non-ED cohorts, adjusting for age, sex, payer, and HHS region. RESULTS: Weekly COVID-19 ED visits preceded Long COVID claims, with the strongest association at a two-week lag during the Omicron BA.1 period, lengthening to three weeks during the BA.4/BA.5, XBB, and EG.5 periods. The median interval from a COVID-related ED encounter to the first Long COVID diagnosis was 22 days, compared with 26 days following non-ED encounters. Crude incidence was highest among Medicare Fee-for-Service beneficiaries (155 per 10,000), individuals over 70 (156 per 10,000), with higher rates in females than males (81 vs. 59 per 10,000). Claims clustered in High Plains and Northwest Texas. CONCLUSION: Administrative claims data can characterize the documented burden of Long COVID and identify high-incidence regions and Medicare-heavy populations that may require expanded post-acute care capacity.