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What is the association of a COVID-19 diagnosis and mobility and physical function among community-living middle-aged and older Canadians during the initial pandemic lockdown in 2020?
This cohort study of 24 114 participants found that community-living middle-aged and older adults with confirmed, probable, or suspected COVID-19 had nearly 2-fold higher odds of worsening mobility and physical function compared with adults without COVID-19, although most participants with COVID-19 had mild to moderate disease and were not hospitalized.
These findings suggest that individuals with mild and moderate COVID-19 who were predominantly not hospitalized experienced deficits in functional mobility compared with those without COVID-19.
The association of COVID-19 not requiring hospitalization with functional mobility in community-dwelling adults above and beyond the impact of the pandemic control measures implemented in 2020 remains to be elucidated.
To evaluate the association between a COVID-19 diagnosis and change in mobility and physical function of adults in Canada aged 50 years or older during the initial pandemic lockdown.
Design, Setting, and Participants
This population-based cohort study used data from the Canadian Longitudinal Study on Aging (CLSA) COVID-19 study. This study was launched on April 15, 2020, and the exit questionnaires were completed between September and December 2020. Prepandemic data from the first CLSA follow-up (2015-2018) were also used. Respondents included middle-aged and older community-dwelling participants residing in Canadian provinces. Data were analyzed from February to May 2021.
The assessment for self-reported COVID-19 status was adapted from the Public Health Agency of Canada and the Centers for Disease Control and Prevention case definition available at the time of data collection; cases were classified as confirmed or probable, suspected, or non–COVID-19.
Main Outcomes and Measures
Changes in mobility since the start of the COVID-19 pandemic were assessed using global rating of change in mobility scales at the COVID-19 exit questionnaire. Participant-reported new onset of difficulty in 3 physical function tasks was also examined.
Among 51 338 participants at baseline, 21 491 participants (41.9%) were 65 years or older and 26 155 participants (51.0%) were women and 25 183 (49.1%) were men. Of 24 114 participants who completed the COVID-19 exit questionnaire, 2748 individuals had confirmed, probable or suspected COVID-19. Of 121 individuals with confirmed or probable COVID-19, 113 (93.3%) were not hospitalized. Individuals with confirmed or probable COVID-19 had higher odds of worsening mobility in terms of ability to engage in household activity (odds ratio [OR], 1.89; 95% CI, 1.11-3.22), physical activity (OR, 1.91; 95% CI, 1.32-2.76), and standing up after sitting in a chair (OR, 2.33; 95% CI, 1.06-5.11) compared with adults without COVID-19 during the same pandemic time period. Similar results were found for suspected COVID-19 status (eg, household activity: OR, 2.09; 95% CI, 1.82-2.41).
Conclusions and Relevance
This cohort study among older adults in Canada found that receiving a COVID-19 diagnosis was significantly associated with worse mobility and functioning outcomes even in the absence of hospitalization. These findings suggest that interventions may be needed for individuals with mild to moderate COVID-19 who do not require hospitalization.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: December 6, 2021.
Published: January 12, 2022. doi:10.1001/jamanetworkopen.2021.46168
Correction: This article was corrected on February 14, 2021, to fix errors in the presentation of data in the Abstract, main text, and Supplement 1.
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Beauchamp MK et al. JAMA Network Open.
Corresponding Author: Parminder Raina, PhD, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 309A McMaster Innovation Park (MIP), 1280 Main St. W. Hamilton, ON L8S 4K1, Canada (firstname.lastname@example.org).
Author Contributions: Dr Raina had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Beauchamp and Joshi contributed equally as co–first authors.
Concept and design: Beauchamp, McMillan, Basta, Kirkland, Raina.
Acquisition, analysis, or interpretation of data: Beauchamp, Joshi, Erbas Oz, Griffith, Kirkland, Wolfson, Raina.
Drafting of the manuscript: Beauchamp, Joshi, McMillan, Raina.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Beauchamp, Erbas Oz, Raina.
Obtained funding: Kirkland, Wolfson, Raina.
Administrative, technical, or material support: Basta, Kirkland, Raina.
Conflict of Interest Disclosures: None reported.
Funding/Support: Funding for the support of the CLSA COVID-19 Questionnaire-based study was provided by Juravinski Research Institute, Faculty of Health Sciences, McMaster University, Provost Fund from McMaster University, McMaster Institute for Research on Aging, Public Health Agency of Canada and Government of Nova Scotia. Funding for the Canadian Longitudinal Study on Aging (CLSA) is provided by the Government of Canada through the Canadian Institutes of Health Research (CIHR) under grant No. LSA 94473 and the Canada Foundation for Innovation.
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.
The Canadian Longitudinal Study on Aging Team: The Members of the Canadian Longitudinal Study on Aging Team are listed in Supplement 2.
Disclaimer: The opinions expressed in this manuscript are the authors’ own and do not reflect the views of the Canadian Longitudinal Study on Aging.
Additional Contributions: This research was conducted using the CLSA Baseline Tracking Dataset version 3.7, Baseline Comprehensive Dataset version 5.1, Follow-up 1 Tracking Dataset version 2.2, Follow-up 1 Comprehensive Dataset version 3.0, CLSA Sample Weights Version 1.2, and COVID-19 questionnaire data under Application ID No. 21CON001. The CLSA is led by Drs. Raina, Wolfson, and Kirkland. Dr Raina holds the Raymond and Margaret Labarge Chair in Optimal Aging and Knowledge Application for Optimal Aging, is the Director of the McMaster Institute for Research on Aging and the Labarge Centre for Mobility in Aging, and holds a Tier 1 Canada Research Chair in Geroscience. Dr Beauchamp holds a Tier 2 Canada Research Chair in Mobility, Aging, and Chronic Disease. Lauren Griffith is supported by the McLaughlin Foundation Professorship in Population and Public Health.
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