Prevalence and risk factors of disability and anxiety in a retrospective cohort of 432 survivors of Coronavirus Disease-2019 (Covid-19) from China

Siyi Zhu; Qiang Gao; Lin Yang; Yonghong Yang; Wenguang Xia; Xiguo Cai; Yanping Hui; Di Zhu; Yanyan Zhang; Guiqing Zhang; Shuang Wu; Yiliang Wang; Zhiqiang Zhou; Hongfei Liu; Changjie Zhang; Bo Zhang; Jianrong Yang; Mei Feng; Zhong Ni; Baoyu Chen; Chunping Du; Hongchen He; Yun Qu; Quan Wei; Chengqi He; Jan D Reinhardt

doi:10.1371/journal.pone.0243883

Prevalence and risk factors of disability and anxiety in a retrospective cohort of 432 survivors of Coronavirus Disease-2019 (Covid-19) from China

PLoS One. 2020 Dec 17;15(12):e0243883. doi: 10.1371/journal.pone.0243883. eCollection 2020.

Authors

Siyi Zhu^{1

2}, Qiang Gao^{1

2}, Lin Yang^{1

2}, Yonghong Yang^{1

2}, Wenguang Xia³, Xiguo Cai⁴, Yanping Hui⁵, Di Zhu⁶, Yanyan Zhang⁷, Guiqing Zhang⁸, Shuang Wu⁹, Yiliang Wang¹⁰, Zhiqiang Zhou¹¹, Hongfei Liu¹², Changjie Zhang¹³, Bo Zhang¹⁴, Jianrong Yang¹⁵, Mei Feng¹⁶, Zhong Ni¹⁶, Baoyu Chen¹, Chunping Du^{1

2}, Hongchen He^{1

2}, Yun Qu^{1

2}, Quan Wei^{1

2}, Chengqi He^{1

2

17}, Jan D Reinhardt^{17

18

19

20}

Affiliations

¹ Rehabilitation Medical Center, West China Hospital, Sichuan University, Chengdu, China.
² Rehabilitation Medicine Key Laboratory of Sichuan Province, Sichuan University, Chengdu, China.
³ Hubei Hospital of Integrated Traditional Chinese and Western Medicine, Wuhan, Hubei, China.
⁴ Henan Provincial People's Hospital, Zhengzhou, Henan, China.
⁵ The Second Affiliated Hospital, Medical College of Xi'an Jiaotong University, Xian, Shanxi, China.
⁶ Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China.
⁷ Qilu Hospital of Shandong University, Jinan, Shandong, China.
⁸ The First Affiliated Hospital, School of Medicine, Shihezi University, Xinjiang, China.
⁹ The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China.
¹⁰ Chongqing Three Gorges Central Hospital, Chongqing, China.
¹¹ Inner Mongolia Autonomous Region Baotou Central Hospital, Baotou, China.
¹² General Hospital of General Bureau of Agricultural Reclamation of Heilongjiang Province, Harbin, China.
¹³ The Second Xiangya Hospital of Central South University, Changsha, China.
¹⁴ Nanchong Central Hospital, Nanchong, Sichuan, China.
¹⁵ Garze People's Hospital, Garze Tibetan Autonomous Prefecture, Sichuan, China.
¹⁶ Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
¹⁷ Institute for Disaster Management and Reconstruction of Sichuan University and Hong Kong Polytechnic University, Sichuan University, Chengdu, China.
¹⁸ Swiss Paraplegic Research, Nottwil, Switzerland.
¹⁹ Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland.
²⁰ Xidian Hospital Group, Xi'an, Shaanxi, China.

Abstract

Objective: 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.

Publication types

Clinical Trial
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living
Adult
Age Factors
Aged
Anxiety Disorders* / epidemiology
Anxiety Disorders* / psychology
COVID-19* / mortality
COVID-19* / psychology
China / epidemiology
Disabled Persons*
Female
Humans
Male
Middle Aged
Prevalence
Retrospective Studies
Risk Factors
SARS-CoV-2*
Survivors*

Grants and funding

This study was supported by the National Natural Science Foundation (81972146 to CH; 82002393 to SZ), the Department of Science and Technology of Sichuan Province (20YYJC3320 to CH; 21ZDYF1918/21YYJC2860 to SZ), China Postdoctoral Science Foundation (2020M673251), Health Commission of Sichuan Province (20PJ034), Xi’an Bureau of Technology to JDR(XA2020-HWYZ-0043), the Fundamental Research Funds for the Central Universities, China to JDR (20827041D4161), and West China Hospital of Sichuan University (HX-2019-nCoV-011 to CH; 2019HXBH058 to SZ). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.