Abstract
BackgroundPeople with chronic conditions are disproportionately prone to be affected by the COVID-19 pandemic but there are limited data documenting this. We aimed to assess the health, psychosocial and economic impacts of the COVID-19 pandemic on people with chronic conditions in India.MethodsBetween July 29, to September 12, 2020, we telephonically surveyed adults (n = 2335) with chronic conditions across four sites in India. Data on participants’ demographic, socio-economic status, comorbidities, access to health care, treatment satisfaction, self-care behaviors, employment, and income were collected using pre-tested questionnaires. We performed multivariable logistic regression analysis to examine the factors associated with difficulty in accessing medicines and worsening of diabetes or hypertension symptoms. Further, a diverse sample of 40 participants completed qualitative interviews that focused on eliciting patient’s experiences during the COVID-19 lockdowns and data analyzed using thematic analysis.ResultsOne thousand seven hundred thirty-four individuals completed the survey (response rate = 74%). The mean (SD) age of respondents was 57.8 years (11.3) and 50% were men. During the COVID-19 lockdowns in India, 83% of participants reported difficulty in accessing healthcare, 17% faced difficulties in accessing medicines, 59% reported loss of income, 38% lost jobs, and 28% reduced fruit and vegetable consumption. In the final-adjusted regression model, rural residence (OR, 95%CI: 4.01,2.90–5.53), having diabetes (2.42, 1.81–3.25) and hypertension (1.70,1.27–2.27), and loss of income (2.30,1.62–3.26) were significantly associated with difficulty in accessing medicines. Further, difficulties in accessing medicines (3.67,2.52–5.35), and job loss (1.90,1.25–2.89) were associated with worsening of diabetes or hypertension symptoms. Qualitative data suggest most participants experienced psychosocial distress due to loss of job or income and had difficulties in accessing in-patient services.ConclusionPeople with chronic conditions, particularly among poor, rural, and marginalized populations, have experienced difficulties in accessing healthcare and been severely affected both socially and financially by the COVID-19 pandemic.
Highlights
People with chronic conditions are disproportionately prone to be affected by the COVID-19 pandemic but there are limited data documenting this
3% were diagnosed or treated for COVID-19, 1% were hospitalized, and 69% reported that they had heard of a confirmed case of COVID-19 in their locality, more in urban (72%) than rural (58%) sites
About two-third of respondents experienced fear/anxiety related to COVID-19 and nearly half reported moderate difficulty in coping with stress during the COVID-19 lockdowns
Summary
People with chronic conditions are disproportionately prone to be affected by the COVID-19 pandemic but there are limited data documenting this. People with chronic conditions are disproportionately prone to COVID-19–related hospitalizations, intensive care admissions, and mortality, compared to those without chronic conditions [4,5,6,7]. They may be susceptible to adverse health impacts from delayed or foregone care during the pandemic. The 2020 World Health Organization (WHO) report on the impact of COVID-19 on noncommunicable diseases (NCDs) in 163 countries highlighted that nearly half of the countries report that patients experienced partial or complete disruption of services for hypertension, diabetes, and related complications during the pandemic. Given the syndemic interaction ─interrelationship between COVID-19 and various socio-ecological and biological factors contributing to preexisting NCD epidemics─ people with chronic conditions are more vulnerable to COVID-19 infection [15, 16]
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