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Health, psychosocial, and economic impacts of the COVID-19 pandemic on people with chronic conditions in India: a mixed methods study

  • Singh, Kavita1, 2
  • Kondal, Dimple1
  • Mohan, Sailesh1, 2, 3
  • Jaganathan, Suganthi2
  • Deepa, Mohan4
  • Venkateshmurthy, Nikhil Srinivasapura1, 2
  • Jarhyan, Prashant1
  • Anjana, Ranjit Mohan4
  • Narayan, K. M. Venkat5
  • Mohan, Viswanathan4
  • Tandon, Nikhil6
  • Ali, Mohammed K.5
  • Prabhakaran, Dorairaj1, 2, 7
  • Eggleston, Karen8
  • 1 Public Health Foundation of India, Plot number 47, Sector 44, Gurugram, New Delhi, Haryana, 122002, India , New Delhi (India)
  • 2 Centre for Chronic Disease Control, New Delhi, India , New Delhi (India)
  • 3 Deakin University, Melbourne, Australia , Melbourne (Australia)
  • 4 Madras Diabetes Research Foundation, Chennai, India , Chennai (India)
  • 5 Emory University, Atlanta, GA, USA , Atlanta (United States)
  • 6 All India Institute of Medical Sciences, New Delhi, India , New Delhi (India)
  • 7 London School of Hygiene and Tropical Medicine, London, UK , London (United Kingdom)
  • 8 Stanford University, Stanford, California, USA , Stanford (United States)
Published Article
BMC Public Health
Springer (Biomed Central Ltd.)
Publication Date
Apr 08, 2021
DOI: 10.1186/s12889-021-10708-w
Springer Nature


BackgroundPeople with chronic conditions are disproportionately prone to be affected by the COVID-19 pandemic but there are limited data documenting this. We aimed to assess the health, psychosocial and economic impacts of the COVID-19 pandemic on people with chronic conditions in India.MethodsBetween July 29, to September 12, 2020, we telephonically surveyed adults (n = 2335) with chronic conditions across four sites in India. Data on participants’ demographic, socio-economic status, comorbidities, access to health care, treatment satisfaction, self-care behaviors, employment, and income were collected using pre-tested questionnaires. We performed multivariable logistic regression analysis to examine the factors associated with difficulty in accessing medicines and worsening of diabetes or hypertension symptoms. Further, a diverse sample of 40 participants completed qualitative interviews that focused on eliciting patient’s experiences during the COVID-19 lockdowns and data analyzed using thematic analysis.ResultsOne thousand seven hundred thirty-four individuals completed the survey (response rate = 74%). The mean (SD) age of respondents was 57.8 years (11.3) and 50% were men. During the COVID-19 lockdowns in India, 83% of participants reported difficulty in accessing healthcare, 17% faced difficulties in accessing medicines, 59% reported loss of income, 38% lost jobs, and 28% reduced fruit and vegetable consumption. In the final-adjusted regression model, rural residence (OR, 95%CI: 4.01,2.90–5.53), having diabetes (2.42, 1.81–3.25) and hypertension (1.70,1.27–2.27), and loss of income (2.30,1.62–3.26) were significantly associated with difficulty in accessing medicines. Further, difficulties in accessing medicines (3.67,2.52–5.35), and job loss (1.90,1.25–2.89) were associated with worsening of diabetes or hypertension symptoms. Qualitative data suggest most participants experienced psychosocial distress due to loss of job or income and had difficulties in accessing in-patient services.ConclusionPeople with chronic conditions, particularly among poor, rural, and marginalized populations, have experienced difficulties in accessing healthcare and been severely affected both socially and financially by the COVID-19 pandemic.

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