Chronic Conditions, Disability, and COVID-19 Testing and Vaccination: A National Rapid Acceleration of Diagnostics-Underserved Populations Analysis.

IF 3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology Pub Date : 2025-09-24 DOI:10.1016/j.annepidem.2025.09.019

Haley R Fonseca, Elizabeth Lydon, Troy A Stefano, Eileen Fluney, Lisa Wruck, Susanna Stevens, Krista M Perreira, David R Brown, Wensong Wu, Marianna K Baum

{"title":"Chronic Conditions, Disability, and COVID-19 Testing and Vaccination: A National Rapid Acceleration of Diagnostics-Underserved Populations Analysis.","authors":"Haley R Fonseca, Elizabeth Lydon, Troy A Stefano, Eileen Fluney, Lisa Wruck, Susanna Stevens, Krista M Perreira, David R Brown, Wensong Wu, Marianna K Baum","doi":"10.1016/j.annepidem.2025.09.019","DOIUrl":null,"url":null,"abstract":"Purpose: We investigated the impact of chronic conditions on COVID-19 testing, vaccination, and related challenges, with a focus on the interaction effect of disability.Methods: This cross-sectional, cross-consortium analysis was conducted as part of the National Institutes of Health Rapid Acceleration of Diagnostics-Underserved Population (RADx-UP) initiative. Data were self-reported via standardized RADx-UP common data elements. Multivariable generalized estimating equation models with a logit link adjusted for sociodemographic variables, health insurance, health status, housing, and United States region were utilized.Results: Participants were from 28 states (n=8,813), enrolled between February 2021-March 2022 with a mean age of 49 years, 60.4% female, 30.8% Hispanic, and 25.5% Black, non-Hispanic. Over 30% were living with three or more chronic conditions and 22.1% reported some type of disability. Odds of COVID-19 testing (aOR:1.95; 95%CI:1.75, 2.17), vaccination (aOR:1.63; 95%CI:1.31, 2.03), food insecurity (aOR:1.43; 95%CI:1.21, 1.68), housing insecurity (aOR:1.42; 95%CI:1.10, 1.82), healthcare access challenges (aOR:1.60; 95%CI:1.38, 1.86) and transportation challenges (aOR:1.48; 95%CI:1.21, 1.81) increased as number of chronic conditions increased. The effect of chronic conditions on probability of COVID-19 testing (p=0.157) and vaccination (p=0.147) did not differ by disability, but the effect on probability of experiencing COVID-19-related challenges did differ by disability (p<0.001). For those with functional and employment disability, the more chronic conditions one had, the more likely they were to experience food insecurity (aOR:1.94; 95%CI:1.33, 2.82) and issues accessing healthcare (aOR:2.21; 95%CI:1.19, 4.14) and transportation (aOR:2.33; 95%CI:1.11, 4.89).Conclusions: Testing and vaccination sites may have been accessible to various populations and/or adults with chronic conditions may have had heightened awareness of potential vulnerability to COVID-19, which could have led to similar testing and vaccination behaviors across different disability statuses. However, disability may still exacerbate daily-life challenges in those living with chronic conditions during public health crises.","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":" ","pages":""},"PeriodicalIF":3.0000,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Epidemiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.annepidem.2025.09.019","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose: We investigated the impact of chronic conditions on COVID-19 testing, vaccination, and related challenges, with a focus on the interaction effect of disability.

Methods: This cross-sectional, cross-consortium analysis was conducted as part of the National Institutes of Health Rapid Acceleration of Diagnostics-Underserved Population (RADx-UP) initiative. Data were self-reported via standardized RADx-UP common data elements. Multivariable generalized estimating equation models with a logit link adjusted for sociodemographic variables, health insurance, health status, housing, and United States region were utilized.

Results: Participants were from 28 states (n=8,813), enrolled between February 2021-March 2022 with a mean age of 49 years, 60.4% female, 30.8% Hispanic, and 25.5% Black, non-Hispanic. Over 30% were living with three or more chronic conditions and 22.1% reported some type of disability. Odds of COVID-19 testing (aOR:1.95; 95%CI:1.75, 2.17), vaccination (aOR:1.63; 95%CI:1.31, 2.03), food insecurity (aOR:1.43; 95%CI:1.21, 1.68), housing insecurity (aOR:1.42; 95%CI:1.10, 1.82), healthcare access challenges (aOR:1.60; 95%CI:1.38, 1.86) and transportation challenges (aOR:1.48; 95%CI:1.21, 1.81) increased as number of chronic conditions increased. The effect of chronic conditions on probability of COVID-19 testing (p=0.157) and vaccination (p=0.147) did not differ by disability, but the effect on probability of experiencing COVID-19-related challenges did differ by disability (p<0.001). For those with functional and employment disability, the more chronic conditions one had, the more likely they were to experience food insecurity (aOR:1.94; 95%CI:1.33, 2.82) and issues accessing healthcare (aOR:2.21; 95%CI:1.19, 4.14) and transportation (aOR:2.33; 95%CI:1.11, 4.89).

Conclusions: Testing and vaccination sites may have been accessible to various populations and/or adults with chronic conditions may have had heightened awareness of potential vulnerability to COVID-19, which could have led to similar testing and vaccination behaviors across different disability statuses. However, disability may still exacerbate daily-life challenges in those living with chronic conditions during public health crises.

查看原文本刊更多论文

慢性病、残疾和COVID-19检测和疫苗接种：全国快速加速诊断——服务不足人群分析。

目的：研究慢性疾病对COVID-19检测、疫苗接种和相关挑战的影响，重点研究残疾的相互作用效应。方法：作为美国国立卫生研究院快速加速诊断服务不足人群（RADx-UP）计划的一部分，进行了横断面、跨联盟分析。数据通过标准化RADx-UP通用数据元素自我报告。采用了对社会人口变量、健康保险、健康状况、住房和美国地区进行调整的带有logit链接的多变量广义估计方程模型。结果：参与者来自28个州（n=8,813），于2021年2月至2022年3月期间入组，平均年龄49岁，60.4%为女性，30.8%为西班牙裔，25.5%为非西班牙裔黑人。超过30%的人患有三种或三种以上的慢性病，22.1%的人报告了某种类型的残疾。COVID-19检测（aOR:1.95; 95%CI:1.75, 2.17）、疫苗接种（aOR:1.63; 95%CI:1.31, 2.03）、食品不安全（aOR:1.43; 95%CI:1.21, 1.68）、住房不安全（aOR:1.42; 95%CI:1.10, 1.82）、医疗保健获取挑战（aOR:1.60; 95%CI:1.38, 1.86）和交通挑战（aOR:1.48; 95%CI:1.21, 1.81）的几率随着慢性病数量的增加而增加。慢性疾病对COVID-19检测概率（p=0.157）和疫苗接种概率（p=0.147）的影响没有因残疾而异，但对经历COVID-19相关挑战概率的影响确实因残疾而异(p)。不同人群和/或患有慢性疾病的成年人可能对COVID-19的潜在易感性有更高的认识，这可能导致不同残疾状况的人进行类似的检测和接种疫苗行为。然而，在公共卫生危机期间，残疾仍可能加剧慢性病患者的日常生活挑战。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Annals of Epidemiology 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.40

自引率

1.80%

发文量

207

审稿时长

59 days

期刊介绍： The journal emphasizes the application of epidemiologic methods to issues that affect the distribution and determinants of human illness in diverse contexts. Its primary focus is on chronic and acute conditions of diverse etiologies and of major importance to clinical medicine, public health, and health care delivery.