Impact of the COVID-19 pandemic on physical and mental health over time in relation to chronic disease status and urbanicity

Both direct and indirect health effects of living in COVID-19 pandemic conditions have been reported. General measures taken to manage the pandemic may impact physical and mental health and probably disproportionately affect chronically diseased individuals. Residents of urban and rural areas may be differently affected as well. The aim of this study is to assess the impact of the COVID-19 pandemic and the measures to manage the outbreak on physical and mental health, and whether the impact on wellbeing differs according to chronic disease status and urbanicity. Participants of three Dutch prospective cohorts (AMIGO, VGO and PIAMA; n=27,763) were invited. The VGO cohort is situated mainly in a rural region, while the other two cohorts are mixed in terms of urbanicity. Respondents (n=5,420) were asked to complete an online baseline questionnaire regarding health status, followed by monthly follow-up questionnaires between September 2020 and October 2021. Questions on physical and mental health were answered using 5-point Likert scores (PHS/MHS). Chronic disease status included asthma, chronic obstructive pulmonary disease (COPD), diabetes and cardiovascular disease. Cumulative link mixed models adjusted for age, sex and BMI, were used to analyze the longitudinal data. Preliminary results show that participants from the more rural cohort reported better PHS (OR=0.59,95%CI=0.48-0.71) and MHS (0.54,95%CI=0.43-0.66) compared to participants from the mixed urban/rural cohorts. Asthma and COPD were associated with worse PHS (OR=2.41;95%CI=1.90-3.09). The same was found for diabetes (OR= 2.23;95%CI=1.53-3.24) and cardiovascular disease (OR=2.16,95%CI=1.68-2.76). Similar associations were found for MHS. Results suggest that both urbanicity and chronic disease status are relevant factors to consider when assessing (indirect) health effects of the COVID-19 pandemic. Additional multivariable analyses including detailed urbanicity indicators and stringency of governmental measures over time will be performed enabling deeper understanding of individual drivers of these effects. COVID-19, urbanicity, urban-rural, chronic disease