Abstract
Background: Long COVID presents a substantial public health challenge, with symptom clusters varying across populations. Rural-urban disparities in health outcomes and healthcare access may influence both the manifestation of Long COVID and the adoption of health behaviors. This study aimed to compare Long COVID symptom clusters and subsequent health behavior adaptations between urban and rural populations.Methods: A cross-sectional survey was conducted from March to July 2023 among adults in Ireland who had confirmed COVID-19 at least 12 weeks prior. Participants (n=1,248) were recruited from urban (n=624) and rural (n=624) primary care centers. Symptom clusters were assessed using a validated Long COVID symptom inventory covering fatigue, respiratory, cognitive, and mental health domains. Health behavior adaptation was measured using a composite scale evaluating physical activity, diet, sleep, and healthcare engagement. Multivariate linear regression examined the association between rurality and adaptation.Results: Rural participants reported significantly higher prevalence of fatigue (78.2% vs. 68.9%, p=0.001) and cognitive symptom clusters (52.4% vs. 44.9%, p=0.009), while respiratory symptoms were similar. Health behavior adaptation scores were lower in rural areas (mean 58.3 vs. 64.7, pConclusions: Rural populations experience a greater burden of certain Long COVID symptom clusters and exhibit poorer adaptation of health behaviors. Targeted interventions addressing health literacy, accessible rehabilitation services, and remote monitoring are urgently needed to mitigate rural health inequities in the post-COVID era.