COVID-19 clinical outcomes by patient disability status: A retrospective cohort study

Providing accessible health information for people with disability in a public health crisis: A qualitative study of the experiences of Australian accessible information provider organizations during the COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic, people with disability had a right and an acute need to access accessible COVID-19 information, in formats such as sign language, Braille, large print and Easy Read/English. Yet such information was not always provided and many people with disability were without sufficient accessible information.

OBJECTIVE

This paper explores the experiences of Australian accessible information provider organizations of producing accessible information during the pandemic. The intent is to understand why insufficient accessible information reached people with disability.

METHODS

In-depth interviews were conducted with 17 accessible information provider organizations and one other stakeholder in Australia, and thematically analyzed.

RESULTS

The findings show that accessible information provider organizations felt an immense depth and breadth of responsibility for providing accessible information to people with disability during the pandemic. However, they were hampered by constantly changing information; workforce challenges; and a lack of financial, logistic and partnership assistance. Other notable difficulties included having no source of clear/accurate information to translate to accessible formats and not having medical/health expertise themselves.

CONCLUSION

The findings have implications for better preparation for accessible information access in future public health crises. There should be greater funding and logistic support for accessible information provider organizations. Provision of clear/accurate information and subject matter checks of accessible products would be helpful. Responsibility for this should be scoped into existing outreach, education and communications roles - for example, in local health services, general practice clinics and government health departments.

Age-Stratified Risk of Severe COVID-19 for People With Disabilities in Korea: Nationwide Study Considering Disability Type

BACKGROUND

Understanding disparities in severe coronavirus disease 2019 (COVID-19) outcomes between people with disabilities (PwD) and people without disabilities (PwoD) is crucial, particularly when considering the heterogeneity within PwD and age differences. This study aimed to compare severe COVID-19 outcomes including deaths between PwD and PwoD with analyses stratified by age group and further examined by disability type.

METHODS

This retrospective, population-based cohort study used linked data from national COVID-19 cases and health insurance for individuals aged ≥ 19 years with COVID-19 from January 2020 to October 2022 in the Republic of Korea. Severe outcomes included severe cases and deaths, with logistic regression analysis of the risk disparities between PwD and PwoD based on age group and disability types. The subgroup analysis considered epidemic periods, accounting for the severe acute respiratory syndrome coronavirus 2 variant circulation.

RESULTS

The risk of severe COVID-19 outcomes and deaths among PwD varied by age and disability type. While severe outcomes were most prevalent in the older age groups for both PwD and PwoD, younger PwD faced a markedly higher risk-up to eightfold-compared to PwoD. The risk of disability status was greater than that of comorbidities in the 19-39 age group. Among disability types, individuals with internal organs-related and intellectual disabilities showed higher risk disparities with PwoD in severe outcomes than other types of disabilities. Throughout the pandemic, the disparity in death risk remained similar, with a slight increase in disparity during the omicron period for all severe outcomes in the age groups 19-39 and 40-64 years.

CONCLUSION

Prioritizing younger PwD, along with older age groups and people with comorbidities, is crucial in addressing public health crises. Risk-based prioritization is important to reduce overall risk. This includes prioritizing people with nternal organs-related and intellectural disabilities, who face higher health risks among PwD during a pandemic when resources are limited and time is of the essence.

Social Determinants of Health Affect Psychological Distress among People with Disabilities

People with disabilities experience inequitable exposure to social determinants of health (SDOH) that contribute to disparate health outcomes, including psychological distress. There is little research examining which SDOH have the strongest effect on psychological distress among people with disabilities. This leaves healthcare providers and policy makers with insufficient information to make well-informed treatment decisions or allocate resources effectively. We explored the association between SDOH and disability and which factors may moderate the association between disability and psychological distress. Using data from the US Census Bureau's Household Pulse Survey (Phase 3.5), we examined SDOH among people with and without disability (n = 26,354). Among people with disability, the odds of severe psychological distress were highest among those who had low incomes (OR = 4.41, 95% CI: 3.51-5.60), were food insecure (OR = 3.75, 95% CI: 3.43-4.10), housing insecure (OR = 3.17, 95% CI: 2.82-3.58), or were unable to work (OR = 1.98, 95% CI: 1.80-2.18). Only difficulty paying for household expenses moderated the association between disability and severe psychological distress (OR = 9.81, 95% CI: 7.11-13.64). These findings suggest that supporting employment and economic opportunities and improving access to safe and affordable housing and food may improve psychological well-being among people with disabilities.

Mortality trends in people with disabilities before and during the COVID-19 pandemic in South Korea, 2017-2022

Objective

To investigate temporal trends in mortality rates and underlying causes of death in persons with disabilities before and during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

Annual mortality rates and causes of death were analyzed using data covering the 2017-2022 period.

Results

The mortality rate among people with disabilities increased from 2017 to 2022; the rate was five times higher during COVID-19 in this population than in the general population. When analyzing the cause of death, the incidence of infectious diseases and tuberculosis decreased after COVID-19. In contrast, the incidence of other bacillary disorders (A30-A49) increased. The incidence of respiratory system diseases (J00-J99), influenza and pneumonia (J09-J18), and other acute lower respiratory infections (J20-J22) decreased before COVID-19, while the incidence of lung diseases due to external agents (J60-J70), other respiratory diseases principally affecting the interstitium (J80-J84), and other diseases of the pleura (J90-J94) increased during the pandemic. The risk of COVID-19 death among people with disabilities was 1.1-fold higher for female patients (95% CI = 1.06-1.142), 1.41-fold for patients aged 70 years and older (95% CI = 1.09-1.82), and 1.24-fold higher for people with severe disabilities (95% CI = 1.19-1.28).

Conclusions

The mortality rate in people with disabilities significantly increased during COVID-19, compared with that before the pandemic. People with disabilities had a higher mortality rate during COVID-19 compared with the general population. Risk factors must be reduced to prevent high mortality rates in this population.

Partners in vaccination: A community-based intervention to promote COVID-19 vaccination among low-income homebound and disabled adults

BACKGROUND

Care managers (CM) for low-income disabled clients may address COVID-19 vaccine hesitancy with specific training.

OBJECTIVE

To assess the Partners in Vaccination (PIV) that trained CMs of a homecare program for disabled adults to promote COVID-19 vaccination.

METHODS

We randomized 78 CMs to PIV intervention (N = 38) or control (N = 40). PIV featured motivational interviewing (MI) skills and educational materials for unvaccinated clients. The primary outcome was first COVID-19 vaccination between December 1, 2021 and June 30, 2022 for clients of intervention CMs versus control CMs. Mixed method analysis included key informant interviews conducted from 5/24/22 to 7/25/22 with CMs, administrators, and clients about the PIV intervention.

RESULTS

Among 1939 clients of 78 study CMs, 528 (26.8 %) were unvaccinated by December 1, 2021 (274 clients of intervention CMs; 254 clients of control CMs). These clients' mean age was 62.3 years old (SD = 22.4) and 54 % were Black or Hispanic/Latino. First vaccination rate did not differ for intervention and control groups (6.2 % vs. 5.9 %, p = .89) by 6/30/2022. Barriers to addressing COVID-19 vaccination from interviews with 7 CMs and administrators were competing responsibilities and potentially antagonizing clients. Seven interviewed clients (five vaccinated and two unvaccinated) cited concerns about vaccination they heard from their family/friends and belief that risks of COVID-19 infection may be less than vaccination. Yet, some clients were receptive to physician recommendations.

CONCLUSION

Training CMs to promote COVID-19 vaccination for disabled clients did not increase first vaccination rates. CMs preferred their usual role of coordinating care and, even after the training, expressed discomfort with this potentially polarizing topic.

The association of multiple sclerosis, traumatic brain injury, and spinal cord injury to acute and long COVID-19 outcomes

BACKGROUND

Although persons with disabilities are a high-risk group, little is known about the association between specific disabling conditions and acute or long COVID outcomes.

OBJECTIVE

To examine the severity of acute SARS-CoV-2 infection and post-COVID outcomes among people with a preexisting diagnosis of multiple sclerosis (MS), spinal cord injury (SCI), or traumatic brain injury (TBI).

METHODS

This was a retrospective cohort study using the TrinetX Research Database, a large representative database of medical records. COVID-19-positive persons with MS, SCI, or TBI (cases) were matched 1:1 on age, gender, race, ethnicity, and comorbidities to COVID-19-positive persons without these diagnoses (controls). The main outcomes assessed were hospitalization for acute COVID-19, length of stay (LOS), the total number of hospitalizations, mortality, and incidence of six prevalent post-COVID sequelae within 6 months following a COVID-19 diagnosis.

RESULTS

There were 388,297 laboratory-confirmed COVID-19 cases identified. Of these cases, 2204 individuals had one of the following preexisting diagnoses: 51.3% TBI, 31.4% MS, and 17.3% SCI. People with TBI, MS, and SCI were significantly more likely to be hospitalized for COVID-19 (odds ratio [OR] = 1.22, 95% confidence interval [CI] = 1.03-1.46) than matched controls. There was no difference in LOS, total hospitalizations, or mortality during the 6 months following the initial COVID diagnosis. Multivariable analyses reveal that persons with TBI, MS, and SCI were more likely to experience new weakness (OR = 1.54, 95% CI = 1.19-2.00), mobility difficulties (OR = 1.66, 95% CI = 1.17-2.35), and cognitive dysfunction (OR = 1.79, 95% CI = 1.38-2.33) than controls, even after controlling for the presence of these symptoms prior to their COVID infection and other risk factors. There were no differences in fatigue, pain, or dyspnea.

CONCLUSIONS

Having a history of MS, SCI or TBI was not associated with higher mortality risk from COVID-19. However, associations between these diagnoses and postacute COVID-19 symptoms raise concern about widening health outcome disparities for individuals with such potentially disabling conditions following COVID-19 infection.

Adults With IDD in Supported Accommodation During COVID-19 Lockdown: The Families' Perspective

The present study aims to understand and describe family caregivers' perceptions and experiences regarding contact and relationships with their adult relatives with intellectual and developmental disabilities (IDD) living in supported accommodation during the COVID-19 lockdown. A qualitative phenomenological approach was applied in which 19 Israeli family caregivers (parents and siblings) were interviewed. Inductive thematic analysis revealed themes at the microsystem level (the resident, the caregiver, and their relationship), and at the mesosystem level (the caregivers' interactions with service providers and other residents' families). The findings highlight the pivotal role of family caregivers in times of uncertainty and the need to develop explicit policies and mechanisms to facilitate family engagement in the residents' lives.

The mortality experience of disabled persons in the United States during the COVID-19 pandemic

New data from the Social Security Administration suggest there were 260 000 excess deaths in the United States among current or former disability beneficiaries during the first 22 months of the COVID-19 pandemic. These beneficiaries accounted for 26% of all excess deaths in the United States during this period. The pattern of deaths among disabled beneficiaries corresponds closely to known milestones in the pandemic's history. Disabled beneficiaries in New York, particularly those residing in institutions, had extremely elevated mortality with the onset of the pandemic in the spring of 2020. Across all regions in the United States, mortality among disability beneficiaries increased sharply with the onset of the winter of 2020-2021 and with the emergence of the Delta and Omicron variants in 2021. Elevated mortality was observed for persons with intellectual, mental, and physical impairments. Future public information campaigns about vaccines and other measures may be more successful if they include specific efforts to directly target disability beneficiaries. In addition, clinical trials and other research should consider including disabled persons as specific study groups as the severity of their underlying health impairments is likely comparable to that of persons of advanced age.