Health Disparities
Disparities in Recovery of Activities of Daily Living Among Survivors of Respiratory Failure due to COVID-19 Kaitlyn Parrotte* Kaitlyn Parrotte Parrotte New York University, School of Global Public Health
Survivors of respiratory insufficiency and failure experience persistent functional limitations and reduced quality of life after hospitalization. However, studies that explicitly examine the association between social determinants and recovery remain limited. We examined the influence of race/ethnicity, financial strain, and pre-hospitalization living situation on 12-month functional recovery among survivors of respiratory insufficiency and failure. We identified 338 participants enrolled in BLUE CORAL, a NHLBI-funded, multi-center prospective observational study of patients with COVID-19, who had a post-discharge measurement for activities of daily living (ADL) at 1-month, 3-months, 6-months, and 12-months. The ADL index was scored from 0 to 14, with 0 indicating no activity restrictions. We assessed baseline financial strain via the question “At the end of each month over the past 3 months, did you or your household have enough money left over to make ends meet?”, which used a 4-point scale with 1 representing “not enough”. Pre-hospitalization living situation was consolidated into two categories: home independently and home with help or facility. We evaluated associations between race/ethnicity, financial strain, and patient location with function of patients at 1-, 3-, 6-, and 12-months using a generalized estimating equations model, adjusting for race, sex, age, admission location, comorbidities, severity of illness, and baseline function. Greater financial resources were associated with better functional recovery. Compared to participants reporting insufficient funds, those with “just enough” money had 1.27 fewer ADL limitations (p=0.003), “some money left over” had 1.42 fewer restrictions (p=0.001), and “more than enough money left over” had 1.58 fewer restrictions (p<0.001). ADL recovery did not differ significantly by race/ethnicity or pre-hospital living situation across the four timepoints. Insufficient financial resources may contribute to worse outcomes. Future research should examine financial toxicity as a barrier to long-term functional recovery.