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Association Between Risk Factors for Complications From COVID-19, Perceived Chances of Infection and Complications, and Protective Behavior in the US

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Do adults with risk factors for COVID-19 complications understand their elevated risk and undertake fewer higher infection risk behaviors?

Findings  In this survey study of 6084 US adults, those with 7 of 9 medical risk factors for COVID-19 complications reported higher perceived chance of hospitalization or death from COVID-19 if infected compared with those without the factor. While nearly all adults reported recent mask wearing, during several common activities the majority, including susceptible adults, did not consistently wear masks.

Meaning  Adults with medical risk factors for COVID-19 complications understood their risks were higher, but consistent mask wearing remained low.

Abstract

Importance  It is unknown whether adults who are susceptible to severe complications from COVID-19 recognize their susceptibility and modify behavior to reduce exposure.

Objective  To determine whether adults with risk factors for COVID-19 complications perceive an elevated chance of complications and undertake fewer higher infection risk behaviors.

Design, Setting, and Participants  This cross-sectional analysis, adjusted for sociodemographic characteristics, included civilian noninstitutionalized US adults of wave 18 of the Understanding America Study collected from November 11 to December 9, 2020.

Exposures  US Centers for Disease Control and Prevention–identified medical risk factors for COVID-19 complications and older age.

Main Outcomes and Measures  Primary outcomes were perceived percentage chance of infection and hospitalization and death if infected; whether 9 potentially higher infection risk activities were undertaken in the past week and, if so, whether a mask was worn; whether a mask was worn anywhere in the past week; and attitudes toward 12 aspects of mask wearing.

Results  In Understanding America Study wave 18 (n = 5910 participants with nonmissing data), the mean age was 48 years, and 52% were women. The response rate was 77%. Adults with 7 of 9 medical risk factors and aged 70 years and older reported a higher perceived chance of complications if infected. Adjusted mean perceived chance of hospitalization if infected ranged from 23.9% (95% CI, 22.2%-25.5%) for those with high blood pressure to 40.4% (95% CI, 34.6%-46.2%) for those with chronic lung disease and was associated with number of medical risk factors: 17.6% (95% CI, 16.4%-18.8%) and 41.8% (95% CI, 38.7%-45.0%) for adults with 0 vs 3 or more medical risk factors, respectively. Fewer potentially higher infection risk activities were undertaken by adults with 3 or more vs 0 risk factors: 2.83 (95% CI, 2.66-2.99) vs 3.12 (95% CI, 3.02-3.22). Wearing a mask sometime last week was nearly universal (90.1%). But during only 1 specific activity (visiting a grocery store or pharmacy) did more than half always wear a mask, and for only 1 activity (visiting a grocery store or pharmacy) was mask wearing more common among adults with 3 or more vs 0 conditions.

Conclusions and Relevance  In this cross-sectional survey study, adults with risk factors for COVID-19 complications reported higher perceived susceptibility to complications. During common activities, including visiting with friends, the majority of adults, including the highly susceptible, did not consistently wear masks.

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Article Information

Accepted for Publication: February 9, 2021.

Published: March 31, 2021. doi:10.1001/jamanetworkopen.2021.3984

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Schoeni RF et al. JAMA Network Open.

Corresponding Author: Robert F. Schoeni, PhD, Institute for Social Research, University of Michigan, 426 Thompson St, Ann Arbor, MI 48104 (bschoeni@umich.edu).

Author Contributions: Drs Schoeni and Wiemers had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Schoeni, Seltzer.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Schoeni, Seltzer.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Schoeni, Wiemers.

Administrative, technical, or material support: Schoeni, Seltzer.

Supervision: Schoeni.

Conflict of Interest Disclosures: Dr Seltzer reported being affiliated with a research and training center at University of California at Los Angeles that receives funding from the National Institute of Child Health and Human Development. This funding supports the infrastructure of the center, and it does not contribute to Dr Seltzer’s salary. Dr Langa reported grants from the National Institutes of Health/National Institute on Aging and grants from the Alzheimer’s Association outside the submitted work. No other disclosures were reported.

Funding/Support: The collection of the UAS COVID-19 tracking data is supported in part by the Bill & Melinda Gates Foundation and by grant U01AG054580 from the National Institute on Aging, and many others. This article was prepared with support, in part, from the Center for Aging and Policy Studies at Syracuse University, which receives core support (P30AG066583) from the National Institute on Aging, and by the California Center for Population Research at the University of California at Los Angeles, which receives core support (P2C-HD041022) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the University of Southern California or the UAS. The authors have not published nor submitted any related articles from the same study.

Additional Information: The project described in this article relies on data from survey(s) administered by the Understanding America Study, which is maintained by the Center for Economic and Social Research at the University of Southern California.

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