Background/Purpose:

COVID-19 has caused global disruptions in the management of chronic illnesses. The extent to which patients with rheumatic disease have been affected by COVID-19 and the related changes to methods of health service delivery is unknown. We present a model capturing the effects of the pandemic on the physical and mental health of a sample of adult patients with rheumatic disease.

Methods:

The COVID-19 Global Rheumatology Alliance Patient Experience Survey was disseminated online to patients with rheumatic disease. Patients reported age, gender, WHO region, employment status, ethnicity, change in employment status, smoking status, current rheumatic disease control, methods of communicating with rheumatologist, medications, possible exposure to COVID-19, COVID-19 diagnosis, hospitalization due to COVID-19, mental/physical health, and methods taken to protect from COVID-19, were entered in two multivariable regression models. The two models assessed the associations with the entered variables with PROMIS Global Health Mental and Global Health Physical scales.

Results:

Out of 9,393 patients, 1,544 were removed due to missingness. PROMIS Global Health Physical was associated with the additive independent predictors entered into the model with a large effect size (R2adj = 0.41, F = 123.744, 7804, p < 0.001). After adjusting for employment status, region, ethnicity, age, disease activity, smoking status, medications, and gender, patients unable to communicate with their rheumatologist reported a decreased physical health (-0.25, p < 0.001). Patients who quarantined, or those with COVID-19 diagnosis, experienced worse physical health (-0.18, p < 0.001; -0.21, p < 0.001). PROMIS Global Health Mental was associated with the independent predictors with a moderate effect size (R2adj = 0.27, F = 67.9444, 7804, p < 0.001). Patients who have not needed to communicate with their rheumatologist, were hospitalized with COVID-19, and had COVID-19 expressed better mental health (0.14, p = 0.022; 0.67, p < 0.01; 0.31, p < 0.01). Patients who identified possible contact with COVID-19 expressed a lower mental health state (0.15, p < 0.001).

Conclusion:

By modeling the effects of COVID-19 behaviors and health care service delivery, we demonstrated that patients unable to communicate with their rheumatologist, quarantined, and/or with COVID-19, experienced decreased physical health. In contrast, patients experienced better mental health if they reported no need to communicate with their rheumatologist, had COVID-19, and/or were hospitalized due to COVID-19.

It is evident that COVID-19 caused worse physical health, however, having or surviving COVID-19 paradoxically led to improved mental health. It is possible that these patients perceived a reduced mortality risk, despite the consequences to their physical health.

In contrast, patients who reported potential COVID-19 exposures endorsed poorer mental health, perhaps due to a greater perceived risk of mortality. Further exploration of patient characteristics and behaviors in a principal component analysis may provide additional insight into the experience of patients with rheumatic disease amidst a global pandemic.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/modeling-the-effects-of-covid-19-protective-behaviors-and-healthcare-delivery-on-the-health-of-patients-with-rheumatic-disease/