Health Disparities among People with and without Diabetes during COVID-19: An 18-Month Evaluation

ABSTRACT

This study describes the mental health of US adults with and without diabetes (ND) over an 18-month period of the COVID-pandemic. A 12-month web-based survey was administered in May 2020 (N = 2,176) to June 2021 and November 2021 (18MO;N = 1,192) including demographics, pandemic experiences, depression (PHQ-8) and anxiety (GAD-7) symptoms, perceived stress (PSS) , and resilience (BRS) . Mean age of 18MO Completers (55%) was 53 years (SD = 16.4) , primarily female (80%) , White (91%) , with an annual household income of ≥ $60,000 (58%) . 165 had type 2 diabetes (T2D;14%) , 83 had prediabetes (7%) , and 56 had type 1 (T1D;5%) . Completers were more likely to be White, educated (45% post-master's degree) , and homeowners with fewer medical and emotional comorbidities at baseline than non-completers (all p<.05) . At 18MO, mean PHQ-8 score was 5.2 (SD = 5.3;mild) , GAD-7 was 4.1 (SD = 4.8) , PSS was 13.2 (SD = 5.5) . All improved from baseline (p<.001) . Ages 18-30 had the highest scores on anxiety (M = 6.1;SD = 5.4) and perceived stress (M = 16.5;SD = 8.3) compared to other age groups (p<.001) . At 18MO, rates of COVID-infection (9.1%;p<.001) , knowing someone with COVID- (86.7%) , loss from COVID- (40.7%) and pandemic burnout (M = 2.6, SD = 2.1) were increased. Greatest burnout was reported by women (M = 2.9, SD = 2.1) , 18-30 y.o.s (M = 3.5, SD = 2.0) and T1Ds (M = 3.5, SD = 1.7) , all p<.05. Financial disparities persisted at all time points. At 18MO, women (15.98%) and Latinos (28.57%) reported difficulty paying monthly bills (p<.001) . Asian/American Indian/Multiracial (23.73%) subgroup reported worsening financial situations compared to Whites (p<.001) . 51-64 y.o.s reported difficulty paying bills (20.4%) , less financial optimism (13.4%) and worsening financial situation (21.45%) compared to other age groups (p<.001) . Over 18 months, mental health outcomes improved slightly while gender, age, ethnic and racial disparities persisted as personal exposure to COVID-and pandemic burnout increased.