Prevalence and risk factors of disability and anxiety in a retrospective cohort of 432 survivors of Coronavirus Disease-2019 (Covid-19) from China
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Abstract
To estimate the prevalence of disability and anxiety in Covid-19 survivors at discharge from hospital and analyze relative risk by exposures.
Design
Multi-center retrospective cohort study.
Setting
Twenty-eight hospitals located in eight provinces of China.
Methods
A total of 432 survivors with laboratory-confirmed SARS CoV-2 infection participated in this study. At discharge, we assessed instrumental activities of daily living (IADL) with Lawton’s IADL scale, dependence in activities of daily living (ADL) with the Barthel Index, and anxiety with Zung’s self-reported anxiety scale. Exposures included comorbidity, smoking, setting (Hubei vs. others), disease severity, symptoms, and length of hospital stay. Other risk factors considered were age, gender, and ethnicity (Han vs. Tibetan).
Results
Prevalence of at least one IADL problem was 36.81% (95% CI: 32.39–41.46). ADL dependence was present in 16.44% (95% CI: 13.23–20.23) and 28.70% (95% CI: 24.63–33.15) were screened positive for clinical anxiety. Adjusted risk ratio (RR) of IADL limitations (RR 2.48, 95% CI: 1.80–3.40), ADL dependence (RR 2.07, 95% CI 1.15–3.76), and probable clinical anxiety (RR 2.53, 95% CI 1.69–3.79) were consistently elevated in survivors with severe Covid-19. Age was an additional independent risk factor for IADL limitations and ADL dependence; and setting (Hubei) for IADL limitations and anxiety. Tibetan ethnicity was a protective factor for anxiety but a risk factor for IADL limitations.
Conclusion
A significant proportion of Covid-19 survivors had disability and anxiety at discharge from hospital. Health systems need to be prepared for an additional burden resulting from rehabilitation needs of Covid-19 survivors.
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SciScore for 10.1101/2020.08.26.20182246: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The study protocol was approved by the ethics committee of West China Hospital, Sichuan University (2020-273).
Consent: Subjects: Four hundred and thirty-two Covid-19 survivors were surveyed who had received treatment in 28 designated hospitals in Hubei, Sichuan, Guizhou, Henan, Neimenggu (inner Mongolia), Shandong, Hainan, and Chongqing from January 18 to March 15, 2020 and gave informed consent.Randomization not detected. Blinding not detected. Power Analysis Measures: Sample size calculation: Sample size to detect a two-fold relative risk for reporting one or more IADL limitations in the severe disease group as compared to the non-severe group with a power … SciScore for 10.1101/2020.08.26.20182246: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The study protocol was approved by the ethics committee of West China Hospital, Sichuan University (2020-273).
Consent: Subjects: Four hundred and thirty-two Covid-19 survivors were surveyed who had received treatment in 28 designated hospitals in Hubei, Sichuan, Guizhou, Henan, Neimenggu (inner Mongolia), Shandong, Hainan, and Chongqing from January 18 to March 15, 2020 and gave informed consent.Randomization not detected. Blinding not detected. Power Analysis Measures: Sample size calculation: Sample size to detect a two-fold relative risk for reporting one or more IADL limitations in the severe disease group as compared to the non-severe group with a power of 80% and alpha error of 5% was estimated under the following assumptions: 0.2 ratio of severe to non severe group (based on patients received at our own center), 15 percent prevalence of outcome in non-severe group. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:This retrospective cohort study found a considerable prevalence of functional limitations and dependence as well as anxiety in Covid-19 survivors at about time of discharge from acute inpatient treatment. Disease severity was a major independent risk factor for all outcomes. Age was an additional risk factor for both disability outcomes, and setting (Hubei) for IADL limitations and anxiety. Tibetan ethnicity was a strong protective factor for anxiety but a risk factor for IADL limitations when it was adjusted for covariates. Demographic and clinical characteristics of the study population were comparable to other reports on Covid-19 patients from China [1, 21] with two exceptions: a higher percentage was classified as severe cases and current smoking was more prevalent in the non-severe disease group. An explanation for the higher percentage of severe cases in the present study is that the applied criteria for classifying Covid-19 cases as severe by the National Health Commission of the PR China are more liberal than the criteria for severe community-acquired pneumonia by the American Thoracic Society and Infectious Disease Society of America[22] used by Guan et al.[21] The lower prevalence of smokers in participants with severe disease was unexpected and contradicts previous evidence in this regard.[21] A possible explanation is that current smoking status was self-reported and participants with more severe disease outcomes did not reveal their true smoking status, perhaps f...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
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- No protocol registration statement was detected.
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