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":"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。","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":"<p><strong>Purpose: </strong>We investigated the impact of chronic conditions on COVID-19 testing, vaccination, and related challenges, with a focus on the interaction effect of disability.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","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":"{\"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\":\"<p><strong>Purpose: </strong>We investigated the impact of chronic conditions on COVID-19 testing, vaccination, and related challenges, with a focus on the interaction effect of disability.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>\",\"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}","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}
Chronic Conditions, Disability, and COVID-19 Testing and Vaccination: A National Rapid Acceleration of Diagnostics-Underserved Populations Analysis.
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.
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.
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