June 10, 2021

People with acute and chronic diseases are experiencing lower quality of life during COVID-19 pandemic

Individuals who survived a hospitalization for COVID-19, as well as people with diabetes and those with an acute respiratory virus, all experienced a significantly lower health status as compared to the general population.

University of Michigan Family Medicine researchers have published the sentinel work on the effects of COVID-19 (also known as SARS-CoV2) on self-perceived health related quality of life (HRQoL) in individuals with chronic and acute diseases, using a measure that can be directly imported into health economic models for future pandemic planning.

Marie Claire O'Dwyer, MB, BCh, BAO, MPH, assistant professor and director of Resident Scholarly Research in the Department of Family Medicine
Marie Claire O’Dwyer, MB, BCh, BAO, MPH, assistant professor and director of Resident Scholarly Research

Their study -- a first in this field -- titled, “Health related quality of life for people with acute and chronic illnesses during SARS-CoV-2,” was recently published in the Journal of the American Board of Family Medicine. Marie Claire O’Dwyer, MB, BCh, BAO, MPH, assistant professor and director of Resident Scholarly Research in the Department of Family Medicine, is lead author of the paper.

The primary aim of the study was to compare the HRQoL as measured by the Short Form Health Survey (SF) 36 for individuals with a chronic disease (diabetes); those who survived a hospitalization for COVID-19; and those who had an acute respiratory virus not requiring hospitalization and unrelated to COVID-19.

The study’s secondary aim was to compare the sub-scores from the eight health domains of the SF-36, to the general population. Those domains include assessments in physical functioning; role limitations due to physical problems; bodily pain; general health perceptions; vitality; social functioning; role limitations due to emotional problems; and mental health.

A total of 879 individuals were contacted between June 13, 2020 through Sept. 14, 2020 and invited to take part in an anonymous online survey or a phone survey. Researchers contacted 183 people in the diabetic group; 259 in the acute respiratory group; and 437 in the survivors of hospitalization for COVID-19 group. The researchers recruited a total of 132 adult participants for the study.

Survey results showed that all three groups reported a change in health status over the prior four months from study contact due to the pandemic. This health status was significantly lower than the general population. As hypothesized, when comparing among the three groups, the hospitalized group had the worst general health status compared to both the acute respiratory and diabetic groups.

When compared to the general reference population in the U.S., the hospitalized group had significantly lower quality of life in all eight of the health domains; the acute respiratory group was only lower in five domains; and the diabetic group only lower in three domains. All three groups had significantly reduced quality of life in two domains: Pain and Social Functioning.

The hospitalized group that survived COVID-19 had the worst HRQoL measures for all domains, most severely with increased role limitations due to emotional issues and a decreased self-reported change in health status over four months. However, they were the most optimistic about their current general health.

The acute respiratory group rated their current general health the poorest of the three groups. Individuals in this group attributed their significant decreases in general health to expectations that their health would worsen, as well as a sense of fear and a decrease in feeling calm and peaceful. For all other health domains, the acute respiratory group matched the healthier scores of the diabetes group.

“This result is important for future pandemics, when those with seemingly minimal illness but similar symptoms to the fatal pandemic, translate their symptoms … for the worst and develop gloomier health outlooks,” the authors write.

The authors add that race was an important influencer in their study, with the proportion of Black individuals highest in the hospitalized group. Despite this, those of Black race reported significantly higher energy scores and emotional well-being scores in the adjusted models than the white population.

O’Dwyer et al note that although there is an abundance of research examining the psychological effects of those who have lived through and worked during the COVID-19 pandemic, there is no research currently other than this report on the impact of HRQoL on people with acute and chronic diseases.

“This study clarifies that adverse HRQoL is experienced not just by those who contract SARS-CoV2 but by individuals living with chronic disease, as well as those who contract simple non-COVID-19 viral illness,” they write. “As our public health response and mitigation strategies to the COVID-19 pandemic continue to evolve, it is important that the impact of HRQoL is understood and incorporated” into these strategies.

Article Cited: O'Dwyer MC, Meixner K, Albiac LC, et al. Health-Related Quality of Life for People With Acute and Chronic Illnesses During the COVID-19 Pandemic. The Journal of the American Board of Family Medicine. 2021;34(3):509-521. doi:10.3122/jabfm.2021.03.200593.