Public Health Foundation of India, Plot number 47, Sector 44, Gurugram, New Delhi, Haryana, 122002, India.
Centre for Chronic Disease Control, New Delhi, India.
BMC Public Health. 2021 Apr 8;21(1):685. doi: 10.1186/s12889-021-10708-w.
People 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.
Between 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.
One 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.
People 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.
患有慢性病的人更容易受到 COVID-19 大流行的影响，但目前记录这一情况的数据有限。我们旨在评估 COVID-19 大流行对印度慢性病患者的健康、心理社会和经济影响。
2020 年 7 月 29 日至 9 月 12 日，我们在印度的四个地点通过电话调查了患有慢性病的成年人（n=2335）。使用预先测试的问卷收集参与者的人口统计学、社会经济地位、合并症、获得医疗保健的机会、治疗满意度、自我保健行为、就业和收入方面的数据。我们进行了多变量逻辑回归分析，以研究与难以获得药物和糖尿病或高血压症状恶化相关的因素。此外，我们还对 40 名不同的参与者进行了定性访谈，重点了解患者在 COVID-19 封锁期间的经历，使用主题分析对数据进行分析。
1734 人完成了调查（应答率为 74%）。受访者的平均（SD）年龄为 57.8 岁（11.3 岁），其中 50%为男性。在印度 COVID-19 封锁期间，83%的参与者报告难以获得医疗保健，17%的参与者难以获得药物，59%的参与者报告收入损失，38%的参与者失业，28%的参与者减少了水果和蔬菜的摄入。在最终调整的回归模型中，农村居民（OR，95%CI：4.01，2.90-5.53）、患有糖尿病（2.42，1.81-3.25）和高血压（1.70，1.27-2.27）以及收入损失（2.30，1.62-3.26）与难以获得药物显著相关。此外，难以获得药物（3.67，2.52-5.35）和失业（1.90，1.25-2.89）与糖尿病或高血压症状恶化相关。定性数据表明，大多数参与者因失业或收入损失而经历心理社会困扰，并且难以获得住院服务。
患有慢性病的人，尤其是贫困、农村和边缘人群，在获得医疗保健方面遇到困难，并且受到 COVID-19 大流行的严重社会和经济影响。
