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Multicenter Study
. 2021 Jun 16;106(7):e2469-e2479.
doi: 10.1210/clinem/dgab334.

The Impact of the COVID-19 Pandemic on Self-Reported Outcomes in Patients With Adrenal Insufficiency

Dingfeng Li  1 , Malavika Suresh  1 , Tiffany Abbondanza  2 , Anand Vaidya  2 , Irina Bancos  1
Affiliations
Multicenter Study

The Impact of the COVID-19 Pandemic on Self-Reported Outcomes in Patients With Adrenal Insufficiency

Dingfeng Li et al. J Clin Endocrinol Metab. .

Abstract

Context: The COVID-19 pandemic has impacted healthcare environment.

Objective: To determine the impact of the pandemic on self-reported outcomes in patients with adrenal insufficiency (AI).

Design and setting: Prospective longitudinal survey study at 2 tertiary centers.

Participants: Patients with AI.

Intervention: Patient-centered questionnaire.

Main outcome measures: Depression Anxiety Stress Scales-21, Short Form-36, and AI self-management.

Results: Of 342 patients, 157 (46%) had primary AI, 109 (32%) had secondary AI, and 76 (22%) had glucocorticoid-induced AI. When compared to prepandemic, daily glucocorticoid dose and number of adrenal crises did not change. However, patients reported a higher financial impact from AI (34% vs 23%, P = 0.006) and difficulty accessing medical care (31% vs 7%, P < 0.0001) during the pandemic. A third of patients reported difficulty managing AI during the pandemic. After adjusting for duration and subtypes of AI, younger patients [odds ratio (OR) 2.3, CI 95% 1.3-4.1], women (OR 3.7, CI 95% 1.9-7.1), poor healthcare access(OR 4.2, CI 95% 2.3-7.7), lack of good insurance support (OR 2.8, CI 95% 1.3-5.9), and those with a higher financial impact (OR 2.3, CI 95% 1.3-4.3) reported greater difficulties managing AI. Patients were more likely to report a higher anxiety score (≥8) if they found managing AI challenging during the pandemic (OR 3.0, CI 95% 1.3-6.9), and had lower Physical Component Summary (OR 4.9, CI 95% 2.2-11.0) and Mental Component Summary (OR 4.1, CI 95% 1.8-9.5) scores prior to the pandemic.

Conclusions: A third of patients with AI reported difficulties with management of AI during the pandemic, particularly in younger patients, women, and those with poor healthcare access.

Keywords: glucocorticoid therapy; healthcare delivery; psychological resilience; quality of life.

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Figures

Figure 1.
Figure 1.
Quality of life in patients with adrenal insufficiency during the COVID-19 pandemic. Abbreviations: COVID-19, coronavirus disease 2019; SEM, standard error of the mean.
Figure 2.
Figure 2.
(A) Comparison of socioeconomic factors before and during the COVID-19 pandemic. (B) Comparison of quality of life before and during the COVID-19 pandemic. Abbreviations: COVID-19, coronavirus disease 2019; SEM, standard error of the mean.
Figure 3.
Figure 3.
Factors associated with a high self-perceived difficulty with AI management during the pandemic. Abbreviations: AI, adrenal insufficiency; PAI, primary adrenal insufficiency.
Figure 4.
Figure 4.
(A) Factors associated with anxiety during the pandemic. (B) Factors associated with stress during the pandemic. Abbreviations: AI, adrenal insufficiency; COVID-19, coronavirus disease 2019; PAI: primary adrenal insufficiency.
See this image and copyright information in PMC

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