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 = 8813), 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.

Duke Scholars

Author Lisa Wruck Biostatistics & Bioinformatics, Division of Biostatistics