Assessment of Qol among COVID-19 Patients in South India: A Tertiary Care Center Study: An Original Research

ABSTRACT

Introduction:

The COVID-19 epidemic has brought about an unparalleled health disaster and fundamentally altered people’s livelihoods. We intended to examine risk variables for “Health-Related Quality Of Life (HRQoL)” amid COVID-19 hospital discharged patients.

Materials and Techniques:

For this cross-sectional study, 1000 discharged patients who tested positive at the tertiary care center before January 2022 were included. The HRQoL was measured using a 5-level EuroQoL survey. The complete health state was evaluated using an Indian value set. The correlation of HRQoL and the clinical, sociodemographic parameters were investigated using appropriate statistical tools. Finally, regression model was utilized to identify all factors that predict the HRQoL dimensions.

Results:

It was found that 55% of patients said they had moderate or serious health issues. Forty percent of respondents said they had felt moderate-to-severe pain or discomfort, compared to 41% who said they had anxiety or sadness. The outcome of the logistic regression demonstrated the substantial influencers were “age, gender, occupation, location of care, heart conditions, and diabetes” on several HRQoL aspects.

Conclusion:

The COVID-19 dramatically worsens the patients’ physical and mental health conditions. Therefore, the government and policymakers must develop comprehensive ways to lessen the patients’ mental and physical health problems.

INTRODUCTION

On March 11, 2020, the WHO had to designate the COVID-19 virus to be pandemic.[1] Many governments were followed globally to stop the spread of disease.[2] There is little question that the quarantine and health emergency status have a significant interest in observing the pandemic spread. Everything, though, has drawbacks. All public health programs are hampered by patients’ daily lifestyles, which include life satisfaction and social engagement.

The virus is quickly spreading over the world and is responsible for hundreds of fatalities. Since its initial discovery on April 25, 2020, this contagious disease has spread across 210 nations and areas. This is less than 4 months.[1] As of Sep 2022, there were a total of 611,421,786 confirmed cases worldwide, with 6,512,438 deaths.[3] India is attempting to deal with the pandemic scenario like other nations, but the challenge is made more difficult by the socioeconomic conditions. Up until Sep 2022, there had been 3,42,85,612 verified cases of COVID-19 and 4,52,125 total fatalities.[3] COVID-19 causes patients’ mental and physical health to worsen. Patients’ pulmonary systems, as well as their cardiovascular, neurological, hematopoietic, and psychological systems, are all impacted. In addition, massive and unfathomable losses in global economic growth over the course of a year have disrupted patients’ economic and social lives. Because of this, in addition to the medical issue, individuals also frequently deal with many conditions like “post-traumatic stress disorder symptoms, fears of infection, anxiety, boredom, melancholy, disorientation, rage, and insomnia for an extended period of quarantine, insufficient supplies, and loss of money and information.”[1,2,4] Therefore, it is crucial to assess the physical, psychological, and social aspects of patients with COVID-19’s health from a holistic perspective.[5-7]

The quality of health and quantity can both be evaluated using the “Health-Related Quality Of Life (HRQoL)” metric.[2] Several techniques have been created to measure HRQoL. The “EuroQoL 5-Dimensional-5 Levels (EQ-5D-5L)” are a regularly used method in outcome and clinical research to quantify HRQoL by combining five health aspects “self-care, typical activities, mobility, depression/anxiety, and pain/discomfort.”[1] Among COVID-19 hospital released patients, we aimed to investigate risk factors for “Health-Related Quality Of Life (HRQoL)” based on Indian version of the EQ-5D-5L.[8,9]

MATERIAL AND METHODS

Design of the study

The current cross-sectional survey was piloted among COVID-19 patients who were discharged after they recovered from the COVID-19. The participants were admitted with the positive report of the corona, at the tertiary care center. The date of admissions prior to January 2022 was included. The study was conducted for a period of 6 months. All the participants had at least time of 2 months before the survey was answered.

Using a standardized questionnaire and computer-assisted telephone interviews, data was gathered. Social media was used to recruit the participants (e.g., Facebook). There were 1000 interviews conducted in all. To ensure the accuracy of the data, each interview was taped using a recorder in addition to manually filling out the Google Forms questionnaire. It was optional to participate. Incomplete interviews, avoiding phone calls, being disturbed to participate, being untraceable, and doing incomplete interviews were all grounds for exclusion from the study.

Data gathering

We used a structured online survey to assess HRQoL in patients with COVID-19. To ensure the accuracy of the data, we personally filled out the Google Forms form and taped each interview using a recorder. Consent was obtained from the individual by clearly explaining the reason behind the data collection. As a result, participation was optional. To date, we have called 1113 patients. A total of 113 of those patients were not included in the study because they avoided phone calls, were too distressed to participate, gave insufficient answers during interviews, or were unable to be located. Thus, 1000 people made up the whole study population.

HRQoL

We evaluated the patients with COVID-19 who were affected by HRQoL using the EuroQoL 5D (EQ-5D) tool.[8] A descriptive system and a visual analogue scale are included with the instrument (EQ-VAS).[2] The five health characteristics that make up are “mobility, self-care, typical activities, pain/discomfort, and anxiety/depression.” The EQ-5D instrument can assess health status. These dimensions were further divided as “no problems, slight problems, moderate problems, severe problems, and unable to/extreme problems” that can be used to gauge how patients are responding to them.[1] The scoring was from 0 to 100 for the worst–best responses;[2] these all scales were modified to the Indian versions.

Clinical and sociodemographic features

The sociodemographic and clinical parameters employed in this study’s independent variables included “gender, age, education, occupation, physical activity, body mass index (BMI), comorbidities, and location of facility.”

Statistic evaluation

To demonstrate the descriptive character, percentage distribution and frequencies were used. The Chi-square test was applied to determine the relationships amid the sociodemographic and clinical variables and the HRQOL domains. Finally, to identify the predictors of HRQoL, binary logistic regression was fitted. R programming version 4.0 was used to carry out all statistical analyses.

RESULTS

Participants’ sociodemographic information and medical characteristics

The survey received responses from 1000 people in total, including 612 men and 388 women. The majority of participants 52% were under the age of 41. A little under 19% of participants were between the ages of 41 and 49, while 29% were older than 50. In terms of education, 59% had education >10 years, followed by 35% who have a degree or certificate that is between 6 and 10 years old, and 6% who have fewer than 5 years.

Participants in this survey included 53% service holders, 13% of whom were jobless, and 34% of whom held other employment. Sixty-seven percent of people do not consistently exercise, compared to 33% who devote to it. When participants became COVID-19 positive, we discovered that 83% of them received care at home, 17% received care in a hospital, 52% were of normal weight, 43% were overweight, and 5 percent were underweight. Approximately 9% of the participants said they had a cardiac condition. The majority of patients (82%) reported not having hypertension, 15% reported having diabetes, and 98% of the patients did not suffer from stroke.

Quality of life in relation to health

Only 15% of participants on the EQ-5D-5L indicated moderate or severe mobility problems across the five domains. Twelve percent of regular activities had a serious or severe difficulty. Anxiety and depression were the most commonly reported issues; almost 25% of participants experienced moderate or severe issues. Only a small percentage of respondents (3%) reported having a moderate or serious problem with self-care, and 55% of the population under study experienced moderate-to-severe problems.

Relationship between sociodemographic and medical variables and HRQoL

Women (26%) were more likely than men (13%), among the participants, to report a mobility issue. Women also reported more difficulties than men with self-care and daily tasks (7% compared to 1% and 23% compare to 8%, respectively). Senior adults reported problems with their mobility (26%), pain discomfort (59%), anxiety-depression (53%), and regular activities (17%).

The outcome for the QoL of those who were cured of COVID-19 was the opposite. Middle age-groups <41 years were probable than other age-groups to indicate a major difficulty with their quality of life (64%). Respondents with less than five years of education stated that they perceived an issue with quality (68%) and regular activities (21%) as compared to other categories. However, those with 6–10 years of schooling were more probable to have anxiety and/or sadness (53%). Anxiety-depression (47%), regular activities (23%), self-care (11%), and mobility (32%) were problems that unemployed people reported more frequently than other categories. Respondents who did not routinely exercise were probable to experience anxiety and depression (46%) issues than those who did. The most common problems stated by respondents getting care in a hospital during COVID-19 were mobility (26%), self-care (7%), and regular activities (20%). Mobility issues (46%), difficulties doing daily tasks (30%), pain discomfort (54%), and anxiety-depression (56%), all of which were more prevalent in people with heart problems. A problem with mobility and anxiety-depression was mentioned by roughly 22.2% and 52.5% of respondents who had hypertension issues, respectively.

Contrarily, those without hypertension issues were probable to report quality of life issues, while diabetics (60%) had a comparable outcome. The majority of respondents (89%) with any history of stroke were more likely to suffer from anxiety and sadness.

Regression model

The odds ratios for the risks for the various parameters for COVID-19 patients are shown in Table 1.

Table 1.

Regression analysis of the included parameters and COVID-19

Parameter	Variable	Odds ratio	P
Mobility	Sex		0.000
	Women	1
	Men	0.303 (0.165, 0.551)
	Years
	<40	1
	41–50	3.246 (1.54, 6.844)	0.002
	>51	3.91 (2.030, 7.747)	0.000
	Jobs
	Unemployed	1
	Employees	0.353 (0.172, 0.725)	0.004
	Others	0.306 (0.146, 0.640)	0.002
	Exercise
	Doesn’t exercise	1
	Exercises	0.715 (0.394, 1.261)	0.257
	Care center
	Home	1
	Hospital	1.971 (1.056, 3.615)	0.03
	BMI
	Normal weight	1
	Overweight	1.205 (0.658, 2.183)	0.539
	Obesity	1.830 (0.848, 3.858)	0.116
	Cardiac Issues
	Not seen	1
	Seen	4.156 (2.071, 8.351)	0.000
	Blood Pressure
	Absent	1
	Present	1.774 (0.944, 3.281)	0.069
Self-care	Sex		0.002
	Women	1
	Men	0.122 (0.026, 0.434)
	Jobs
	Unemployed	1
	Employees	0.078 (0.01, 0.371)	0.004
	Others	0.241 (0.058, 0.853)	0.032
	Care center
	Home	1
	Hospital	3.664 (1.037, 12.455)	0.037
	Cardiac Issues
	Not seen	1
	Seen	8.969 (2.407, 34.280)	0.001
Usual activities	Sex		0.000
	Women	1
	Men	0.268 (0.145, 0.492)
	Age
	Years	1
	<40	2.625 (1.226, 5.593)	0.012
	41–50	2.311 (1.144, 4.720)	0.019
	Education
	6–10 years	1
	< 5 years	1.494 (0.520, 3.945)	0.431
	>10 years	0.954 (0.498, 1.846)	0.891
	Jobs
	Unemployed	1
	Employees	0.421 (0.192, 0.937)	0.032
	Others	0.486 (0.223, 1.066)	0.069
	Care center
	Home	1
	Hospital	2.137 (1.106, 4.024)	0.021
	Cardiac Issues
	Not seen	1
	Seen	2.770 (1.294, 5.768)	0.007
Pain discomfort	Years
	<40	1
	41–50	1.501 (0.939, 2.387)	0.087
	>51	3.089 (2.024, 4.741)	0.000
	Cardiac Issues
	Not seen	1
	Seen	1.271 (0.683,2.371)	0.447
	Diabetes
	Not seen	1
	Seen	1.689 (1.032, 2.774)	0.037
Anxiety- depression	Years
	<40	1
	41–50	0.945 (0.579, 1.529)	0.819
	>51	1.407 (0.892, 2.217)	0.141
	Education
	6–10 years	1
	< 5 years	0.774 (0.353, 1.694)	0.520
	>10 years	0.510 (0.332, 0.782)	0.002
	Jobs
	Unemployed	1
	Employees	0.996 (0.561, 1.789)	0.989
	Others	0.964 (0.524, 1.777)	0.906
	Regular exercise
	No (ref)	1
	Yes	0.435 (0.285, 0.654)	0.000
	Cardiac issues
	Not seen	1
	Seen	1.250 (0.648, 2.410)	0.502
	Blood Pressure
	Not seen	1
	Seen	1.580 (0.984, 2.541)	0.058
	Diabetes
	Not seen	1
	Seen	1.919 (1.141, 3.247)	0.014
	Stroke
	Not seen	1
	Seen	8.563 (1.412, 165.469)	0.051
Full health	Years
	<40	1
	41–50	0.826 (0.524, 1.309)	0.413
	>51	0.595 (0.388, 0.912)	0.017
	Education
	6–10 years	1
	< 5 years	2.051 (0.958, 4.628)	0.072
	>10 years	1.283 (0.879, 1.871)	0.195
	Blood Pressure
	Not seen	1
	Seen	0.663 (0.419, 1.046)	0.077
	Diabetes
	Not seen	1
	Seen	0.574 (0.349, 0.937)	0.027

Mobility dimension was significantly correlated with sex, age, job, location of hospital care, and cardiac condition. Males had 0.3 times less mobility issues than females; however, persons above the age of 50 had significantly greater mobility issues than those under the age of 41. People with jobs reported 64% less mobility issues than those without jobs; the majority of unemployed people experience anxiety or sadness. The findings indicate that consistent exercise has a big impact in lowering anxiety or sadness. Regular exercisers were 56% less likely than non-regular exercisers to experience anxiety or depression in the post-COVID-19 period. Associated with non-diabetics, diabetics had a higher likelihood of experiencing anxiety or depression. Compared to those under the age of 41, persons over 50 had a 40% lower rate of poor health. People with diabetes were less likely to have a poor quality of life. Table 1.

DISCUSSION

As far as we are aware, this is one of the few researches that has looked at the characteristics that affect HRQoL among COVID-19 subjects who have been discharged and followed-up. According to this study, 41% of COVID-19 patients had either anxiety or sadness. Hasan et al. (2021)[10] conducted a study to assess the psychological status in COVID-19 patients, and they discovered that 47.7% of them had anxiety or depression. Abir et al. (2021)[11] found that 73% of COVID-19 patients had anxiety, while 49% of them had moderate or severe depression. Additionally, the current survey shows that 39% of the respondents had some form of pain or discomfort. In accordance with the present study, Todt et al. (2021)[12] found that in 39.5% pain and discomfort were seen three months after leaving the hospital. Shah et al.[13] revealed that 81% patients experienced pain or discomfort in a global cross-sectional survey.

The study’s findings also showed that, on average, 42% of the subjects had moderate to numerous health issues. HRQoL of COVID-19 patients in China showed that 57.6% still stated having physical problems three months after being discharged in COVID-19.[14] This study was the first to find the association between various factors. Diabetes and age were found to be substantial features connected with pain discomfort and full health, respectively, but sex, occupation, location of care, and heart condition were found statistically significantly associated with self-care problems among COVID-19 patients discharged from the hospital. Additionally, among COVID-19 patients who were released from the hospital, education, exercise, and diabetes were major risk factors for anxiety and sadness. The government and policymakers would benefit from these findings in planning, designing, and implementing appropriate mediations and resolving the obstacles to improving the standard of COVID-19 patients’ healthcare facilities. Similar research was undertaken on 400 COVID-19 patients by Arab-Zozani et al.[1] who saw that cardiac disease; diabetes, hypertension, and diabetes were all significant risk factors for EQ-5D-5L. Indicators of mobility have been crucial in controlling the COVID-19 outbreak in Bangladesh. Male patients reported fewer mobility issues than female patients, according to a US study. Gender did not appear to be a significant risk factor for mobility, as is clear from prior literature.[15] It is also interesting to note that individuals over the age of 50 experience greater mobility issues than patients under the age of 41. A lower degree of movement between regions was associated with a larger ratio of elderly to young persons.[16] Timenetsky et al. investigations revealed that patients’ age was a significant risk factor connected to their amount of mobility in Brazil.[15] In this investigation, the location of the patient’s care was a significant risk factor linked to mobility problems. Patients who stayed in the ICU during the COVID period ran a higher risk of mobility level drop.[15]

According to the current study, male COVID-19 patients who were discharged from the hospital had fewer issues with self-care than female COVID-19 patients. Gender did not appear to be a key determinant for self-care issues, according to a recent case report.[17] According to the study, service users were less likely than unemployed patients to experience self-care issues. Recent data indicates that German workers had less COVID-19 attacks than workers in other nations due to Germany’s steady unemployment insurance system.[18] Particularly, we discovered that patients with heart disease were more likely than their counterparts to experience self-care challenges. According to one study, those with heart issues exhibited fewer self-protective activities.[17]

The results showed that older COVID-19 patients were less likely than younger COVID-19 patients to have greater quality of life scores. Younger patients exhibited higher HRQoL scores than older patients, according to Arab-Zozani et al.[1] This suggests that older patients who had been discharged from the hospital were more negatively impacted by COVID-19 than younger ones. The current study also demonstrated that among COVID-19 patients, having diabetes was a much reduced risk factor for a problem with quality of life. Diabetes may also be a risk factor for 2019-nCoV infection, according to a study.[19] We also discovered, in an interesting development, that age is not a significant risk factor for anxiety and depression issues among COVID-19 patients after being released from the hospital.

On the other hand, compared to their Portuguese counterparts, older persons were associated with a higher risk of anxiety levels.[20] Significant disparities between the anxiety difficulties of patients with 6–10 years of education compared to those with more than 10 years of education were discovered in the current study. These results ran counter to earlier Portuguese study that found that those with higher education were less likely than those with lesser education to experience anxiety.

CONCLUSION

The results of this study show that a sizable proportion of COVID-19 patients had moderate or serious health issues. Additionally, about a quarter of participants reported feeling pain or discomfort as well as anxiety or sadness. In order to help COVID-19 patients regain basic functioning and avoid psychological health issues, thorough efforts should be made to create strategies and programs. The results of this study also demonstrated that the EQ-5D-5L HRQoL dimension was significantly influenced by demographic characteristics such as age, gender, occupation, and location of care, as well as clinical factors such as heart disease and diabetes. Governments and policymakers must therefore devise plans to enhance HRQoL, placing special emphasis on the needs of the elderly, people with heart conditions, and people with diabetes.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.