Data presented at Chest 2021 demonstrated that African American adults disproportionately experience the consequences of COVID-19. A recent study quantified the associations between self-reported COVID-19-related perceptions and stress with measured changes in lung and heart health metrics from before to during the pandemic in a clinical cohort of at-risk African American smokers.
For this study, participants completed lung and heart health assessments, including spirometry, COPD Assessment Test (CAT), blood pressure (BP) measurements and body mass index (BMI). The researchers generated a score depicting change in these clinical outcomes from the year preceding COVID-19 (3/15/2019-3/15/2020) to the year during the pandemic (3/16/2020-3/16/2021), whereby “1” = worsening and “0” = no change/improved values. Study independent variables were the COVID-19 Perception and Stress scales. The perception scale quantified participants’ perceptions of COVID-19 (i.e., likelihood of getting disease, illness severity); higher scores indicate a better understanding of COVID-19 and preventative measures. The stress scale comprised six subscales (ie, fear of contamination, danger, trauma); higher scores indicate higher levels of COVID-19-related stress. Study covariates included age, sex and household density. To assess the relationship between COVID-19-related perceptions and stress with worsening lung and heart health metrics, multivariable logistic regression models for each of the clinical outcomes were generated.
The study found that 48% recorded an increase in CAT score, 53% a decrease in FEV1 and 55% an increase in BMI across the observation period. Mean perception score was 4.41 (SD = .59) and mean stress score was 1.33 (SD = 0.777.5). In adjusted multivariable models, worse COVID-19 perceptions were associated with an increase in CAT (OR = .385, 95% CI = .14-.91) and BP (OR = .345, 95% CI = .10-1.10).
In terms of COVID-19-related stress, increased perception of danger was associated with an increase in CAT score (OR = 1.850, 95% CI = .96-3.93); increased trauma was associated with a decrease in FEV1 (OR = 2.484, 95% CI = .97-8.09). Increased fear of contamination was associated with an increase in BMI (OR = 6.10, 95% CI = 1.87-27.39), whereas greater information checking was associated with a lower or stagnant BMI (OR = .295, 95% CI = .10-.67).
“This single-arm study suggests that in a clinically at-risk population, worse COVID-19 perceptions and related stress are associated with worsening clinical outcomes,” said Navjot A. Kaur, MD, lead researcher and CHEST 2021 presenter. “Health communication strategies to ameliorate inaccurate COVID-19 perceptions and reduce COVID-19-related stress may help reduce the disproportionate COVID-19 clinical burden experienced by African Americans.”