Ogungbe Oluwabunmi, Wang Tianyou, Balte Pallavi P, Slone Sarah E, Meyer Diane, Allen Norrina Bai, Buhr Russell G, Hirsch Jana A, Hinckley Stukovsky Karen, Kucharska-Newton Anna, Gabriel Kelley Pettee, Regan Elizabeth A, Xanthakis Vanessa, Isasi Carmen R, Talavera Gregory, Daviglus Martha, Perreira Krista M, Sims Mario, Contreras Jose Gutierrez, Kandula Namratha R, Lee Joyce S, Howard Virginia J, Judd Suzanne E, Woodruff Prescott, Ortega Victor E, Fretts Amanda M, Wenzel Sally E, Phipatanakul Wanda, Putcha Nirupama, Hansel Nadia, Oelsner Elizabeth, Post Wendy S
Johns Hopkins School of Nursing, Baltimore, Maryland.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
JAMA Netw Open. 2025 Jul 1;8(7):e2520360. doi: 10.1001/jamanetworkopen.2025.20360.
Identifying factors associated with resilience during the COVID-19 pandemic can inform targeted interventions and resource allocation for groups disproportionately affected by systemic inequities.
To examine factors associated with self-reported resilience during the COVID-19 pandemic in racially and ethnically diverse, community-dwelling US adults.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted as part of the Collaborative Cohort of Cohorts for COVID-19 Research (C4R) study, which assessed the associations of the pandemic with self-reported resilience of participants from 14 established US prospective cohorts since January 2021. This report includes participants who responded to the self-reported resilience question on C4R questionnaires. Data was initially analyzed from October 2023 to May 2024, with updated analyses performed from August 2024 to April 2025.
Race and ethnicity, behavior factors, health conditions, and social determinants of health measurements accessed before and during the COVID-19 pandemic through cohort visits and C4R questionnaires.
Self-reported resilience was collected via 1 question (from the Brief Resilience Scale) in C4R questionnaires, "I tend to bounce back quickly after hard times." Participants who answered agree or strongly agree were classified as resilient, and those who reported neutral, disagree, or strongly disagree were classified as not resilient. Modified Poisson regression was performed to estimate prevalence ratios (PRs) and access multivariable-adjusted associations with resilience.
Of 31 045 participants (18 672 [60%] women; 10 746 [34.6%] aged <65 years), 1185 (3.8%) identified as American Indian, 6728 (21.7%) as Black, 293 (0.9%) as East Asian, 6311 (20.3%) as Hispanic, 565 (1.8%) as South Asian, and 15 961 (51.3%) as White; a total of 23 103 participants (74.4%) self-identified as resilient. Compared with White participants, Black and Hispanic participants had higher prevalence of self-reported resilience (adjusted PR [aPR], 1.04; 95% CI, 1.02-1.06; aPR, 1.08; 95% CI, 1.06-1.11; respectively) and American Indian and East Asian participants had lower prevalence (aPR, 0.90; 95% CI, 0.86-0.94; aPR, 0.76; 95% CI, 0.68-0.84; respectively). Higher education, being married or living as married, higher income, and overweight were also associated with higher prevalence of resilience. Being female, having diabetes, and being unemployed were associated with lower prevalence of self-reported resilience. Compared with participants with public insurance only, participants with private insurance had higher prevalence of resilience (aPR, 1.07; 95% CI, 1.03-1.10). COVID-19 vaccination and infection statuses were not significantly associated with resilience. Modification analyses showed important racial and ethnic differences in how factors such as hypertension, marital status, and insurance status were associated with resilience.
In this cross-sectional study of 31 045 adults, self-reported resilience varied by race, ethnicity, and sociodemographic factors. These findings highlight the complex interplay of individual and social factors in shaping the perception of resilience.
确定在新冠疫情期间与恢复力相关的因素，可为受系统性不平等影响尤为严重的群体提供有针对性的干预措施及资源分配依据。
研究美国不同种族和族裔的社区居住成年人在新冠疫情期间自我报告的恢复力相关因素。
设计、背景与参与者：这项横断面研究是新冠疫情研究协作队列（C4R）研究的一部分，该研究自2021年1月起评估疫情与来自美国14个现有前瞻性队列参与者自我报告的恢复力之间的关联。本报告纳入了对C4R问卷中自我报告的恢复力问题作出回应的参与者。数据最初于2023年10月至2024年5月进行分析，更新分析于2024年8月至2025年4月进行。
通过队列访视和C4R问卷获取的新冠疫情之前及期间的种族和族裔、行为因素、健康状况以及健康的社会决定因素测量指标。
通过C4R问卷中的1个问题（来自简易恢复力量表）收集自我报告的恢复力，即“我在经历困难时期后往往能迅速恢复”。回答“同意”或“强烈同意”的参与者被归类为有恢复力，报告“中立”“不同意”或“强烈不同意”的参与者被归类为没有恢复力。进行修正泊松回归以估计患病率比（PRs）并分析与恢复力的多变量调整关联。
在31045名参与者中（18672名[60%]为女性；10746名[34.6%]年龄<65岁），1185名（3.8%）为美洲印第安人，6728名（21.7%）为黑人，293名（0.9%）为东亚人，6311名（20.3%）为西班牙裔，565名（1.8%）为南亚人，15961名（51.3%）为白人；共有23103名参与者（74.4%）自我认定为有恢复力。与白人参与者相比，黑人和西班牙裔参与者自我报告的恢复力患病率更高（调整后的PR[aPR]分别为1.04；95%CI，1.02 - 1.06；aPR为1.08；95%CI，1.06 - 1.11），而美洲印第安人和东亚人参与者的患病率较低（aPR分别为0.90；95%CI，0.86 - 0.94；aPR为0.76；95%CI，0.68 - 0.84）。高等教育、已婚或已婚同居、高收入以及超重也与恢复力患病率较高相关。女性、患有糖尿病和失业与自我报告的恢复力患病率较低相关。与仅拥有公共保险的参与者相比，拥有私人保险的参与者恢复力患病率更高（aPR为1.07；95%CI，1.03 - 1.10）。新冠疫苗接种和感染状况与恢复力无显著关联。修正分析显示，高血压、婚姻状况和保险状况等因素与恢复力的关联存在重要的种族和族裔差异。
在这项对31045名成年人的横断面研究中，自我报告的恢复力因种族、族裔和社会人口学因素而异。这些发现凸显了个体和社会因素在塑造恢复力认知方面的复杂相互作用。
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