Clinical Report: Patterns of Long COVID Incidence Over Time in Texas

Overview

This study uses the Texas All-Payer Claims Database (TX-APCD) to examine temporal, demographic, and geographic patterns of documented Long COVID. Claims reveal higher crude incidence among older adults, females, and Medicare Fee-for-Service beneficiaries, with geographic clustering in High Plains and Northwest Texas.

Background

Long COVID can involve persistent or newly emerging symptoms after acute SARS-CoV-2 infection, creating sustained healthcare needs. Population-level information on documented diagnoses, healthcare utilization, and geographic variation remains fragmented. Multi-payer claims databases can complement other surveillance sources and inform postacute care planning.

Data Highlights

• The analysis covers October 2021 through October 2023.

• TX-APCD represents approximately 60% of insured Texans across all 254 counties.

• Crude Long COVID incidence was 155 per 10,000 enrollees among Medicare Fee-for-Service beneficiaries and 156 per 10,000 among individuals older than 70 years.

• Crude incidence was higher among females than males: 81 versus 59 per 10,000 enrollees.

• The median recorded interval to Long COVID diagnosis was 22 days following a COVID-related emergency department (ED) encounter versus 26 days following a non-ED encounter.

Key Findings

• Weekly COVID-19 ED activity preceded Long COVID claims, with the strongest association at a 2-week lag during Omicron BA.1 and a 3-week lag during the BA.4/BA.5, XBB, and EG.5 periods.

• Long COVID was identified through ICD-10-CM code U09.9, counting each person’s first documented diagnosis.

• Among individuals with a Long COVID diagnosis, 44.71% had a prior COVID-related ED visit.

• Documented diagnoses clustered in High Plains and Northwest Texas.

• The age-standardized female-to-male incidence rate ratio was 1.41 (95% CI, 1.20–1.66).

Interpretation

Claims characterize documented disease burden rather than total Long COVID prevalence. Short recorded intervals may reflect healthcare utilization, diagnostic pathways, and coding practices rather than the biological timing of symptom development.

Limitations

TX-APCD excludes populations such as uninsured individuals and veterans, limiting statewide generalizability. Claims do not capture infections identified only through home testing or managed without healthcare contact. Reliance on diagnosis codes may underestimate burden and does not characterize symptom profiles, clinical severity, or functional impairment. Vaccination history and prior infections not captured in claims could not be evaluated.

Clinical Implications

The authors propose expanding postacute care capacity for populations and regions with greater documented burden. Potential approaches include primary care referral pathways, multispecialty follow-up, rehabilitation services, and telehealth-supported specialty consultation. These proposals were not evaluated as interventions in the study.

Conclusion

Multi-payer claims data can support Long COVID surveillance and identify demographic and geographic differences in documented burden. The findings may inform targeted postacute care planning while requiring careful interpretation of coverage, coding, and healthcare-access limitations.

Related Resources & Content

1. Long COVID: major findings, mechanisms and recommendations — Davis HE, McCorkell L, Vogel JM, Topol EJ — Nature Reviews Microbiology, 2023;21:133–146.

2. Surveillance for post-COVID conditions is necessary: addressing the challenges with multiple approaches — Saydah SH, Brooks JT, Jackson BR — Journal of General Internal Medicine, 2022;37:1786–1788.

3. Coding long COVID: characterizing a new disease through an ICD-10 lens — Pfaff ER, Madlock-Brown C, Baratta JM, et al. — BMC Medicine, 2023;21(1):58.

4. Incidence of long COVID diagnoses in 3.6 million U.S. Medicare beneficiaries with COVID-19 — Abul Y, Harris DA, Chachlani P, et al. — The Journals of Gerontology: Series A, Biological Sciences and Medical Sciences, 2025;80(7):glaf108.

5. Sex differences in long COVID — Shah DP, Thaweethai T, Karlson EW, et al. — JAMA Network Open, 2025;8:e2455430.