Analysis of the National Institutes of Health COVID-19 Neuro Databank by geographic region and income status

TL;DR

This study examines how neurologic symptoms of COVID-19 vary by geography and income level, revealing health disparities and common neurological conditions like fatigue and cognitive issues.

Contribution

The paper provides a global epidemiological analysis of neurological manifestations of COVID-19, linking them to geographic and income-based disparities.

Findings

High-income countries, especially the U.S., reported higher rates of neurological comorbidities.

Asia had the highest frequency of severe illness and mortality from COVID-19.

Vaccination and medication use were lowest in Africa and correlated with income levels.

Abstract

While COVID-19 is more commonly known to present and persist in terms of respiratory symptoms, evidence for neurologic manifestations is limited.

This study aims to provide an epidemiological overview of neurologic manifestations of COVID-19. It compares the demographic and clinical profiles of patients based on geographic location and country income classification. Moreover, it describes the neurologic manifestations of Long COVID.

This was a cross-sectional analysis of a multi-country cohort of patients with COVID-19-associated neurologic symptoms enrolled in the COVID-19 Neuro Databank from January 2020 to February 2025. Demographic, clinical and health system-related factors were described. Comparisons among geographic regions and income classifications were performed via analysis of variance and chi-square tests or Fisher’s exact tests.

Majority of the 3,901 patients were from the United States (U.S.) and from high-income countries. The mean age was 57.27±18 years and 54% were males. Neurologic comorbidities were highest in the U.S. whereas non-neurologic comorbidities. Asia had the greatest frequency of severe COVID and mortality. Vaccination and use of COVID-19 medication was lowest in Africa. There were significant associations between COVID-19 vaccination and use of COVID-19 medications with income level. The five leading COVID-19-associated neurologic conditions were neurocognitive disorders, fatigue, headache, anosmia, and ageusia. A subset of Long COVID was identified as thought disorders, fatigue, mood disorders, stroke, headache, and neurocognitive disorders.

This study provides insight into the varying profile and burdens of COVID-19 associated neurologic conditions and the health inequities during the pandemic among geographic and income groups.