Long-Term Impact of the COVID-19 Pandemic on Self-Management of Chronic Conditions: The C3 Study

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ABSTRACT We will extend an active NIA cohort study of diverse, middle age and older adults with ≥1 chronic conditions to assess COVID-19’s long-term and disparate impact on health and healthcare experiences. COVID-19 has become an unprecedented public health threat in modern times, especially for older adults with a chronic illness. As of January 2021, 94% of COVID deaths have been among adults over 55; 92% of those who have died had ≥1 underlying health conditions. Beyond consequences to personal health associated with acquiring COVID-19, the impact of the pandemic may likely extend to non-COVID-19 outcomes as a patient’s ability to self-manage chronic conditions during and after a pandemic may be compromised for several reasons. In March 2020, our team rapidly launched the COVID-19 & Chronic Conditions (C3) study as cases of COVID-19 emerged in the U.S. to assess how adults with ≥1 chronic conditions were responding to the pandemic. Five active studies with uniform data collection on a range of patient-reported outcomes prior to COVID-19 and with electronic health records access were leveraged to establish the C3 cohort; 673 adults in Chicago were interviewed during the 1st week of the outbreak. The cohort was immediately expanded using two of the ‘parent studies’ that also had sites in New York City (n=200; N=873). C3 participants are diverse by socioeconomic status, race, ethnicity, gender, health literacy, and comorbidity. An NIA COVID-19 supplement was awarded in August 2020 to expand the cohort via the parent studies (N=1200) and continue data collection up to 2022; 5 of 7 planned survey waves have been completed (83-94% retention). C3 findings reveal many adults exhibit sustained, high stress due to COVID-19 that impacts lifestyle, treatment adherence, and healthcare use. Disparities by sex, race, ethnicity, and SES also are present. Health professionals and researchers are now voicing concern for possible long-term consequences of COVID-19 on personal health & healthcare. In response, we propose to continue to follow the C3 cohort to capture data 5 years post onset of the U.S. outbreak. All participants will have a ‘Pre-COVID’ baseline and 7+ follow-up assessments to assess trajectories in health care use, patient-reported & chronic disease outcomes. Our primary aims are to: 1) evaluate changes in lifestyle, health behaviors, healthcare use, health status, and chronic disease outcomes from a pre-pandemic baseline through 5 years after onset of COVID-19; 2) determine the extent to which stress, anxiety, and depression contribute to poor health status and chronic disease outcomes through 5 years after the pandemic’s onset. Our secondary aim is to: 3) identify factors that mediate or moderate associations between stress, anxiety, and depression during/after the pandemic with health status and chronic disease outcomes, while our exploratory aim is to: 4) explore whether health disparities by age, sex, race, ethnicity, or socioeconomic status emerge or worsen during/after the pandemic and the contributing role of stress, anxiety, and depression.