Preprints.org · May 29, 2026

Long COVID as a Predictor of Incident Multimorbidity Among U.S. Civilians- Nationally Representative Evidence on Risk, and Downstream Burden

By Alliu I, Thapa S, Azu EU et al.

Long COVID has been associated with elevated risks of individual chronic conditions, but its role in the transition to multimorbidity remains unclear. We analyzed MEPS Panel 24 (2019-2022) data from 4,364 adults free of multimorbidity at baseline. COVID-19 exposure was classified as Long COVID, COVID-recovered, or no COVID. Discrete-time survival models estimated incident multimorbidity risk, and generalized estimating equations assessed healthcare expenditures, health-related quality of life, and inpatient utilization. Long COVID was associated with a 2.54-fold higher hazard of incident multimorbidity compared with no COVID (HR = 2.54; 95% CI: 1.26-5.10), while COVID-recovered participants also had elevated hazard (HR = 1.85; 95% CI: 1.08-3.17). Incident multimorbidity onset was associated with lower physical HRQoL, increased inpatient utilization, and higher healthcare expenditures. Long COVID was independently associated with lower mental HRQoL, while evidence for Long COVID-specific expenditure growth was model-dependent. These findings suggest that Long COVID and resolved COVID-19 infection may increase the risk of transitioning into multimorbidity, supporting integrated chronic disease surveillance, mental health assessment, and coordinated post-COVID care.

doi.org/10.20944/preprints202605.2027.v1Open accessPopulations