Race, Ethnicity, and Gender Differences in Patient Reported Well-Being and Cognitive Functioning Within 3 Months of Symptomatic Illness During COVID-19 Pandemic

Mandy J Hill; Ryan M Huebinger; Imtiaz Ebna Mannan; Huihui Yu; Lauren E Wisk; Kelli N O'Laughlin; Nicole L Gentile; Kari A Stephens; Michael Gottlieb; Robert A Weinstein; Katherine Koo; Michelle Santangelo; Sharon Saydah; Erica S Spatz; Zhenqiu Lin; Kevin Schaeffer; Efrat Kean; Juan Carlos C Montoy; Robert M Rodriguez; Ahamed H Idris; Samuel McDonald; Joann G Elmore; Arjun Venkatesh

doi:10.1007/s40615-024-02124-8

Race, Ethnicity, and Gender Differences in Patient Reported Well-Being and Cognitive Functioning Within 3 Months of Symptomatic Illness During COVID-19 Pandemic

J Racial Ethn Health Disparities. 2024 Aug 22. doi: 10.1007/s40615-024-02124-8. Online ahead of print.

Authors

Mandy J Hill¹, Ryan M Huebinger², Imtiaz Ebna Mannan³, Huihui Yu³, Lauren E Wisk⁴, Kelli N O'Laughlin⁵, Nicole L Gentile^{6

7

8}, Kari A Stephens⁹, Michael Gottlieb¹⁰, Robert A Weinstein¹¹, Katherine Koo¹¹, Michelle Santangelo¹¹, Sharon Saydah¹², Erica S Spatz^{13

14

15}, Zhenqiu Lin^{13

15}, Kevin Schaeffer¹⁶, Efrat Kean^{16

17}, Juan Carlos C Montoy¹⁸, Robert M Rodriguez¹⁸, Ahamed H Idris¹⁹, Samuel McDonald^{19

20}, Joann G Elmore⁴, Arjun Venkatesh^{13

15

21}

Affiliations

¹ Department of Emergency Medicine, McGovern Medical School, UTHealth Houston, 6431 Fannin JJL 475G, Houston, TX, 77030, USA. mandy.j.hill@uth.tmc.edu.
² Department of Emergency Medicine, McGovern Medical School, UTHealth Houston, 6431 Fannin JJL 475G, Houston, TX, 77030, USA.
³ Center for Outcomes Research and Evaluation, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA.
⁴ Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
⁵ Departments of Emergency Medicine and Global Health, University of Washington, Seattle, WA, USA.
⁶ Department of Family Medicine, University of Washington, Seattle, WA, USA.
⁷ Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA.
⁸ Post-COVID Rehabilitation and Recovery Clinic, University of Washington, Seattle, WA, USA.
⁹ Biomedical Informatics & Medical Education, University of Washington, Seattle, WA, USA.
¹⁰ Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA.
¹¹ Cook County Hospital, The CORE Center, Rush University Medical Center, Chicago, IL, USA.
¹² Centers for Disease Control and Prevention, National Center for Immunizations and Respiratory Diseases, Atlanta, GA, USA.
¹³ Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA.
¹⁴ Department of Epidemiology, Yale School of Public Health, New Haven, CT, USA.
¹⁵ Yale Center for Outcomes Research and Evaluation, New Haven, CT, USA.
¹⁶ Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
¹⁷ Center for Connected Care, Thomas Jefferson University, Philadelphia, PA, USA.
¹⁸ Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA.
¹⁹ Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
²⁰ Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
²¹ Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA.

PMID: 39172356
DOI: 10.1007/s40615-024-02124-8

Abstract

Background: Differences in acute COVID-19 associated morbidity based on race, ethnicity, and gender have been well described; however, less is known about differences in subsequent longer term health-related quality of life and well-being.

Methods: This prospective cohort study included symptomatic adults tested for SARS-CoV-2 who completed baseline and 3-month follow-up surveys. Using the PROMIS-29 tool, a validated measure of health and well-being, we compared outcomes at 3 months and change in outcomes from baseline to 3 months among groups with different races, ethnicities, and/or sexes.

Results: Among 6044 participants, 4113 (3202 COVID +) were included. Among COVID + participants, compared to non-Hispanic White participants, Black participants had better PROMIS T-scores for cognitive function (3.6 [1.1, 6.2]) and fatigue (- 4.3 [- 6.6, - 2.0]) at 3 months and experienced more improvement in fatigue over 3 months (- 2.7 [- 4.7, - 0.8]). At 3 months, compared with males, females had worse PROMIS T-scores for cognitive function (- 4.1 [- 5.6, - 2.6]), physical function (- 2.1 [- 3.1, - 1.0]), social participation (- 2.8 [- 4.2, - 1.5]), anxiety (2.8 [1.5, 4.1]), fatigue (5.1 [3.7, 6.4]), and pain interference (2.0 [0.9, 3.2]). Females experienced less improvement in fatigue over 3 months (3.1 [2.0, 4.3]). Transgender/non-binary/other gender participants had worse 3-month scores in all domains except for sleep disturbance and pain interference.

Conclusions: Three months after the initial COVID-19 infection, Black participants reported better cognitive function and fatigue, while females and other gender minoritized groups experienced lower well-being. Future studies are necessary to better understand how and why social constructs, specifically race, ethnicity, and gender, influence differences in COVID-19-related health outcomes. Trials Registration ClinicalTrials.gov Identifier: NCT04610515.

Keywords: COVID-19; Coronavirus; Long COVID; PROMIS outcomes; Registry; SARS-CoV-2.

Associated data

ClinicalTrials.gov/NCT04610515