Association of COVID-19 pandemic-related concern and health routine changes with functioning among individuals with systemic lupus erythematosus.

OBJECTIVE: To examine whether pandemic-related issues were associated with physical functioning, community mobility and cognition among individuals with SLE. METHODS: Participants were recruited (6 October 2020-11 November 2021) for this cross-sectional study from a population-based cohort of individuals with validated SLE in metropolitan Atlanta, as part of an ongoing ancillary study. Pandemic-related issues (concern about the pandemic (very vs somewhat/not at all concerned); changes in physical activity and sleep (less vs more/same); difficulty obtaining food and medications and accessing routine care (any vs none)) were self-reported. Self-reported physical functioning and episodic and working memory performance were reported as t-scores (such that a score of 50=population mean and a 10-point difference=1 SD) and community mobility scores ranged from 0 to 120, with higher scores representing better functioning for all domains. Differences in scores were assessed via t-tests and age-adjusted, sex-adjusted and race-adjusted linear regression. RESULTS: Among 245 participants (mean age, 46 years; 95% female, 77% black), physical functioning t-scores (mean=44) were consistently lower (by 3-5 points) for those who reported concern about the pandemic, less physical activity and sleep, difficulty obtaining food and medications, and accessing routine care. Similarly, community mobility scores (mean=48) were lower (by 10-20 points) for these individuals. There were no substantial differences in episodic memory and working memory t-scores (mean=50 and 47, respectively) by pandemic-related issues. CONCLUSION: We found that physical functioning and community mobility, but not cognition, were lower among those who reported more concern about the pandemic or greater disruptions to health routines. Future studies should explore interventions among these vulnerable individuals with SLE, who already disproportionately suffer from functional impairment, to maintain functioning and prevent adverse outcomes during times of crisis.

Characteristics and factors associated with vaccine hesitancy in a predominantly black systemic lupus erythematosus cohort

1204 Table 1Factors Associated with COVID-19 Vaccine Perception in SLE Patients from the Georgians Organized Against Lupus CohortCategory Sub-Category Overall (n=598) COVID-19 Vaccination Perception Receptive (n=342) Hesitant (n=252) P-Value Socio- demographics Age at Survey Completion (year) 18-34 85 (14.2) 30 (8.8) 55 (21.8) <0.0001 34-54 264 (44.1) 132 (38.6) 131 (52.0) 55+ 249 (41.6) 180 (52.6) 66 (26.2) Gender male 40 (6.7) 24 (7.0) 15 (6.0) 0.6 female 558 (93.3) 318 (93.0) 237 (94.0) Race Non-Black 129 (21.6) 105 (30.7) 23 (9.1) <0.0001 Black 469 (78.4) 237 (69.3) 229 (90.9) Marital Status Never married 203 (34.0) 95 (27.8) 107 (42.6) 0.0001 Married 201 (33.7) 140 (40.9) 59 (23.5) Separated 24 (4.0) 14 (4.1) 9 (3.6) Divorced 104 (17.4) 57 (16.7) 47 (18.7) Widowed 22 (3.7) 15 (4.4) 7 (2.8) Living with Partner 43 (7.2) 21 (6.1) 22 (8.8) Living in Poverty Yes 147 (25.5) 52 (15.8) 94 (38.5) <0.0001 Current Work Status Employed 248 (42.8) 150 (45.6) 97 (39.4) <0.0001 Off work force 125 (21.6) 92 (28.0) 31 (12.6) Unemployed 206 (35.6) 87 (26.4) 118 (48.0) Educational Attainment ≤ High School 159 (27.0) 73 (21.7) 85 (34.3) <0.0001 Some College 186 (31.6) 97 (28.8) 87 (35.1) ≥ College 243 (41.3) 167 (49.6) 76 (30.6) Insurance type Medicare and/or Medicaid 307 (51.6) 160 (46.9) 144 (57.6) <0.0001 Private 233 (39.2) 166 (48.7) 66 (26.4) Under or uninsured 55 (9.2) 15 (4.4) 40 (16.0) Health Care Provider Primary Care Physician visit in past 12 months Yes 505 (84.4) 298 (87.1) 203 (80.6) 0.03 Rheumatologist visit in past 12 months Yes 516 (86.3) 294 (86.0) 220 (87.3) 0.6 Lupus Characteristics Disease Duration (year) Mean ± SD 18.7 ± 10.4 20.4 ± 10.4 16.2 ± 9.7 <0.0001 Age at Lupus Diagnosis (year) Mean ± SD 32.7 ± 11.9 34.4 ± 12.3 30.3 ± 11.1 <0.0001 Disease Activity: Systemic Lupus A tivity Questionnaire (SLAQ) score Mean ± SD 12.6 ± 8.2 12.2 ± 7.7 13.3 ± 8.8 0.1 Organ Damage: Self-Administered Brief Index Damage (BILD) score Mean ± SD 3.3 ± 3.0 3.4 ± 3.2 3.2 ± 2.6 0.4 Organ Damage Group No Damage (BILD=0) 73 (12.2) 41 (12.0) 32 (12.7) 0.9 Mild damage (BILD=1 or 2) 199 (33.3) 116 (33.9) 82 (32.5) Severe damage (BILD≥3) 326 (54.5) 185 (54.1) 138 (54.8) Medications - current glucocorticoids 247 (42.3) 127 (38.1) 120 (48.4) 0.01 methotrexate 35 (6.2) 16 (4.9) 19 (7.9) 0.1 cyclosporine 1 (0.2) 1 (0.3) 0.4 dapsone 8 (1.4) 4 (1.2) 4 (1.7) 0.7 belimumab 29 (5.1) 17 (5.2) 11 (4.5) 0.7 anti-TNF agents 9 (1.6) 5 (1.5) 4 (1.6) 0.9 hydroxychloroquine 415 (70.6) 236 (70.4) 177 (70.8) 0.9 cyclophosphamide 11 (1.9) 7 (2.2) 4 (1.7) 0.8 mycophenolate mofetil 116 (20.2) 59 (18.1) 57 (23.4) 0.1 azathioprine 73 (12.7) 35 (10.7) 38 (15.7) 0.1 rituximab 13 (2.3) 4 (1.2) 9 (3.7) 0.1 Highest Steroid Dose in the past 12 months (mg/day) Mean ± SD 18.7 ± 21.8 17.2 ± 22.5 20.3 ± 21.2 0.3 Sources of trusted COVID-19 information Government 298 (49.8) 202 (59.1) 94 (37.3) <0.0001 News 289 (48.3) 182 (53.2) 103 (40.9) 0.003 Social Media 44 (7.4) 24 (7.0) 20 (7.9) 0.7 Doctors 445 (74.4) 276 (80.7) 165 (65.5) <0.0001 Lupus Advocacy or Support Groups 333 (55.7) 203 (59.4) 128 (50.8) 0.04 COVID-19 Well-Being Concern for COVID-19 in general Not at all concerned 9 (1.5) 2 (0.6) 7 (2.8) 0.049 A little concerned 34 (5.7) 14 (4.1) 20 (8.0) Moderately concerned 77 (13.0) 42 (12.4) 34 (13.6) Very concerned 200 (33.7) 119 (35.0) 79 (31.6) Extremely concerned 274 (46.1) 163 (47.9) 110 (44.0) Concern lupus will worsen 0 (not concerned) 63 (10.8) 39 (11.6) 22 (9.1) 0.5 1 21 (3.6) 15 (4.5) 6 (2.5) 2 18 (3.1) 11 (3.3) 7 (2.9) 3 22 (3.8) 12 (3.6) 10 (4.1) 4 10 (1.7) 6 (1.8) 3 (1.2) 5 57 (9.8) 24 (7.1) 32 (13.2) 6 35 (6.0) 19 (5.6) 16 (6.6) 7 40 (6.8) 24 (7.1) 16 (6.6) 8 63 (10.8) 41 (12.2) 22 (9.1) 9 46 (7.9) 27 (8.0) 19 (7.8) 10 (extremely concerned) 209 (35.8) 119 (35.3) 90 (37.0) Concern for getting infected with COVID-19 0 (not concerned) 43 (7.4) 22 (6.5) 20 (8.3) 0.4 1 15 (2.6) 6 (1.8) 9 (3.8) 2 24 (4.1) 15 (4.5) 9 (3.8) 3 18 (3.1) 10 (3.0) 7 (2.9) 4 17 (2.9) 9 (2.7) 8 (3.3) 5 69 (11.9) 32 (9.5) 37 (15.4) 6 30 (5.2) 20 (5.9) 9 (3.8) 7 39 (6.7) 25 (7.4) 14 (5.8) 8 62 (10.7) 41 (12.2) 21 (8.8) 9 54 (9.3) 31 (9.2) 23 (9.6) 10 (extremely concerned) 209 (36.0) 126 (37.4) 83 (34.6) Concern for someone in family getting infected 0 (not concerned) 37 (6.4) 20 (6.0) 16 (6.6) 0.2 1 14 (2.4) 6 (1.8) 8 (3.3) 2 13 (2.2) 5 (1.5) 8 (3.3) 3 10 (1.7) 5 (1.5) 5 (2.1) 4 12 (2.1) 8 (2.4) 4 (1.7) 5 61 (10.5) 28 (8.4) 33 (13.6) 6 24 (4.1) 14 (4.2) 10 (4.1) 7 30 (5.2) 17 (5.1) 12 (5.0) 8 63 (10.9) 44 (13.2) 19 (7.9) 9 61 (10.5) 41 (12.3) 20 (8.3) 10 (extremely concerned) 254 (43.9) 146 (43.7) 107 (44.2) Vaccination Attitudes Examination (VAX) scale Mistrust (do not feel safe, cannot rely to stop serious infection, do not feel protected) Mean ± SD 3.2 ± 1.6 2.4 ± 1.2 4.2 ± 1.5 <0.0001 Unseen Effect (problems yet to be discovered, unforeseen problems in children, worry about unknown future effects) Mean ± SD 4.1 ± 1.3 3.9 ± 1.2 4.4 ± 1.4 <0.0001 Profiteering (Pharma profits, authorities profit, vaccination programs are a big con) Mean ± SD 2.8 ± 1.5 2.4 ± 1.3 3.4 ± 1.4 <0.0001 Natural Immunity (natural immunity lasts longer, natural exposure gives safest protection, natural exposure is safer) Mean ± SD 2.6 ± 1.3 2.3 ± 1.2 3.0 ± 1.3 <0.0001 VAX score Mean ± SD 3.2 ± 1.0 2.8 ± 0.9 3.8 ± 0.9 <0.0001 Vaccine Beliefs People with lupus have more vaccine side effects Strongly disagree 37 (6.3) 30 (8.8) 6 (2.4) <0.0001 Disagree 81 (13.7) 67 (19.7) 12 (4.8) Neither agree nor disagree 367 (62.0) 209 (61.5) 157 (63.3) Agree 73 (12.3) 26 (7.6) 47 (19.0) Strongly agree 34 (5.7) 8 (2.4) 26 (10.5) Vaccine will flare lupus Strongly disagree 48 (8.1) 41 (12.1) 6 (2.4) <0.0001 Disagree 83 (14.0) 71 (20.9) 10 (4.0) Neither agree nor disagree 382 (64.5) 209 (61.5) 172 (69.4) Agree 54 (9.1) 12 (3.5) 42 (16.9) Strongly agree 25 (4.2) 7 (2.1) 18 (7.3) Vacci e is not as effective in lupus Strongly disagree 71 (12.0) 56 (16.6) 13 (5.2) <0.0001 Disagree 117 (19.8) 90 (26.6) 26 (10.5) Neither agree nor disagree 347 (58.8) 169 (50.0) 177 (71.4) Agree 39 (6.6) 18 (5.3) 21 (8.5) Strongly agree 16 (2.7) 5 (1.5) 11 (4.4) Vaccination Behavior Number of flu shots in the past 3 seasons 0 118 (19.9) 33 (9.7) 85 (33.9) <0.0001 1 86 (14.5) 41 (12.0) 45 (17.9) 2 71 (12.0) 39 (11.4) 32 (12.7) 3 319 (53.7) 228 (66.9) 89 (35.5) Psychosocial Perceived Stress Mean ± SD 15.8 ± 7.0 15.6 ± 7.1 16.1 ± 6.9 0.4 Healthcare Discrimination: Better care if different race/ethnic group Yes 86 (20.1) 53 (20.2) 33 (20.0) 0.9 PROMIS Self-efficacy: manage medication and treatment (T-score) Mean ± SD 49.2 ± 9.4 49.7 ± 9.2 48.5 ± 9.6 0.1 Brief Resilience Scale Mean ± SD 3.6 ± 0.8 3.7 ± 0.8 3.5 ± 0.8 0.02 PROMIS Depression (T-Score) Mean ± SD 49.3 ± 9.3 48.3 ± 8.7 50.5 ± 10.0 0.004 Everyday Discrimination Mean ± SD 1.4 ± 0.6 1.4 ± 0.6 1.5 ± 0.6 0.2 PROMIS=Patient-Reported Outcomes Measurement Information SystemAbstract 1204 Table 2Factors associated with COVID-19 vaccine perception in sle patients from the georgians organized against lupus cohort, multivariate analyses Model 1 Model 2 Model 3 Model 4 Model 5 Model 6 Factor OR (95%CI) P-Value OR (95%CI) P-Value OR (95%CI) P-Value OR (95%CI) P-Value OR (95%CI) P-Value OR (95%CI) P-Value Age at survey (per 5 years↓) 1.3 (1.2-1.4) <0.0001 1.3 (1.2-1.4) <0.0001 1.3 (1.2-1.4) <0.0001 1.3 (1.2-1.4) <0.0001 1.3 (1.2-1.4) <0.0001 1.3 (1.2-1.4) <0.0001 Disease duration (per 5 years↓) 1.0 (0.9-1.2) 0.5 1.0 (0.9-1.2) 0.7 1.0 (0.9-1.2) 0.7 1.0 (0.9-1.2) 0.7 1.0 (0.9-1.2) 0.7 1.0 (0.9-1.1) 0.8 Education (per 3 years↓) 1.5 (1.2-1.8) 0.0003 1.5 (1.2-1.8) 0.0003 1.5 (1.2-1.8) 0.0002 1.5 (1.2-1.8) 0.0004 1.5 (1.2-1.9) 0.0001 1.5 (1.2-1.8) 0.0002 Black race 4.7 (2.7-8.3) <0.0001 4.8 (2.7-8.4) <0.0001 4.7 (2.7-8.4) <0.0001 4.8 (2.7-8.5) <0.0001 5.0 (2.8-8.9) <0.0001 4.7 (2.7-8.4) <0.0001 Female gender 1.4 (0.7-3.0) 0.4 1.4 (0.7-3.0) 0.4 1.4 (0.7-3.1) 0.4 1.4 (0.7-3.0) 0.4 1.5 (0.7-3.3) 0.3 1.4 (0.7-3.0) 0.4 Unemployed vs Employed 1.5 (1.0-2.3) 0.1 1.6 (1.0-2.6) 0.1 1.6 (1.0-2.5) 0.1 1.5 (1.0-2.5) 0.1 1.5 (0.9-2.5) 0.1 1.6 (1.0-2.5) 0.1 Not Married or With Partner 1.2 (0.8-1.8) 0.4 1.2 (0.8-1.8) 0.4 1.2 (0.8-1.8) 0.4 1.2 (0.8-1.8) 0.4 1.2 (0.8-1.8) 0.3 1.2 (0.8-1.8) 0.4 No primary care visit in past year 1.2 (0.7-2.1) 0.4 1.3 (0.7-2.1) 0.4 1.3 (0.8-2.2) 0.4 1.3 (0.8-2.2) 0.4 1.2 (0.7-2.1) 0.4 Disease activity (Systemic Lupus Activity Questionnaire, per 3 units ↑) 1.0 (0.9-1.1) 0.9 1.0 (0.9-1.1) 0.9 1.0 (0.9-1.1) 0.9 1.0 (0.9-1.04) 0.3 1.0 (0.9-1.1) 0.98 Organ damage (Self-Administered Brief Index Damage, per 1 unit↑) 1.0 (0.9-1.04) 0.3 1.0 (0.9-1.04) 0.4 1.0 (0.9-1.04) 0.4 1.0 (0.9-1.04) 0.4 1.0 (0.9-1.04) 0.3 PROMIS Self-efficacy: manage medication and treatment (per 5 units ↓) 1.0 (0.9-1.2) 0.5 Brief Resilience Scale (per 1 unit ↓) 1.2 (0.9-1.5) 0.3 PROMIS Depression (per 5 units ↑) 1.2 (1.0-1.3) 0.01 Everyday Discrimination (per 1 unit ↑) 1.1 (0.8-1.6) 0.5 OR=odds ratio;CI=confidence interval;PROMIS=Patient-Reported Outcomes Measurement Information System;VAX=Vaccination Attitudes Examination.ConclusionsVery high levels (42.1%) of VH persist in a predominantly Black SLE population. Despite lower vaccine uptake, 66.1% with COVID-19 VH had a recent flu vaccine, indicating potential vaccine receptivity. With less trust in the government, news, doctors, and lupus groups, community leaders and peers should lead outreach. Focus should include those who are younger, Black, and from lower socioeconomic groups, particularly with depression.