Prevalence and Functional Outcomes of Post-Exertional Malaise among Adults with prior COVID-19: Results from a Representative Survey of New York City Residents
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Objective
To estimate the prevalence of Post-Exertional Malaise (PEM) among adults with prior COVID-19 and associated mental health and disability outcomes.
Methods
We conducted a cross-sectional analysis of data from a survey of 9,620 adults with prior COVID-19 in New York City, collected May – June 2024. PEM was measured with the DePaul Symptom Questionnaire – Post Exertional Malaise, categorized by symptom duration (< 14 vs. ≥14 hours). Weighted prevalence estimates were stratified by socio-demographic and clinical characteristics. Modified Poisson regression was used to assess the association of PEM with depression, anxiety, and disability.
Results
The prevalence of PEM symptoms was 20.9% overall and 4.0% with symptom duration ≥ 14 hours, representing over 800,000 New Yorkers affected and over 150,000 who meet a diagnostic criterion for ME/CFS. PEM prevalence was higher among women, transgender and non-binary adults, people of color, and lower educational attainment, chronic comorbidities, or disabilities. PEM was associated with 3 - 4 times higher prevalence of mental health outcomes and 4 - 5 times higher disability scores.
Conclusions
PEM symptoms were common and strongly associated with disability and adverse mental health. Screening, pathways to care, and supportive policies are needed to mitigate long-term consequences, particularly among marginalized populations.
