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

摘要 我们将扩大对患有≥1慢性疾病的不同中老年患者的积极的NIA队列研究 评估新冠肺炎S对健康和医疗体验的长期且截然不同的影响的条件。 新冠肺炎在现代已经成为前所未有的公共健康威胁，特别是对老年人来说 患有慢性病。截至2021年1月，94%的COVID死亡病例发生在55岁以上的成年人中；其中92% 已经死亡的人有潜在的健康状况≥1。超越对个人健康的影响 收购新冠肺炎后，大流行的影响可能会延伸到作为患者的非新冠肺炎结果 在大流行期间和之后自我管理慢性病的能力可能会因为几个原因而受到影响。 2020年3月，我们团队迅速启动了新冠肺炎与慢性病(C3)研究，作为 新冠肺炎出现在美国，以评估患有≥1慢性疾病的成年人对 大流行。五项积极的研究，统一收集患者报告的一系列结果的数据 利用新冠肺炎和电子健康记录访问建立了C3队列； 芝加哥在疫情爆发的第一周接受了采访。立即扩大了队列，使用了两个 在纽约市也有站点(n=200；N=873)的“父母研究”。C3参与者的多样性在于 社会经济地位、种族、民族、性别、健康素养和合并症。新浪新冠肺炎增刊 于2020年8月获奖，以通过家长研究(N=1200)扩大队列并继续收集数据 截至2022年；已完成7个计划调查浪潮中的5个(保留率为83-94%)。C3调查结果揭示了许多 成人因新冠肺炎表现出持续的高压力，影响生活方式、治疗依从性和医疗保健 使用。性别、种族、民族和社会经济地位的差异也存在。卫生专业人员和研究人员现在 表达了对新冠肺炎可能对个人健康和医疗保健产生的长期影响的担忧。 作为回应，我们建议继续遵循C3队列，以在美国发病5年后收集数据。 疫情爆发。所有参与者都将有一个‘Pre-COVID’基线和7+后续评估，以评估轨迹 在卫生保健使用中，患者报告和慢性病结果。我们的主要目标是：1)评估变化 在生活方式、健康行为、医疗保健使用、健康状况和大流行前的慢性病后果方面 新冠肺炎发病5年后的基线；2)确定压力、焦虑和 在大流行后的5年里，抑郁会导致健康状况不佳和慢性病结果 开始了。我们的次要目标是：3)找出在压力和压力之间起中介或缓和作用的因素， 大流行期间/之后的焦虑和抑郁与健康状况和慢性病结局有关，而我们的 探索性目标是：4)探索年龄、性别、种族、民族或社会经济地位的健康差异 在大流行期间/之后出现或恶化，以及压力、焦虑和抑郁的促成作用。

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.