Associations of Anxiety during the COVID-19 Pandemic with Patient Characteristics and Behaviors in CKD Patients: Findings from the Chronic Renal Insufficiency Cohort (CRIC) Study

Abstract

Background. Chronic kidney disease (CKD) is associated with anxiety and depression. Although the Coronavirus 2019 (COVID-19) pandemic has increased stressors on patients with CKD, assessments of anxiety, its predictors and consequences on behaviors, specifically virus mitigation behaviors, are lacking. Methods. From June to October 2020, we administered a survey to 1,873 patients in the Chronic Renal Insufficiency Cohort (CRIC) study, asking participants about anxiety related to the COVID-19 pandemic. We examined associations between anxiety and participant demographics, clinical indices, and health literacy and whether anxiety was associated with health-related behaviors and COVID-19 mitigation behaviors. Results. Mean age of the study population was 70 (SD 9.6) years, 47% were women, 39% were Black Non-Hispanic, 14% were Hispanic, and 38% had a history of cardiovascular disease. In adjusted analyses, younger age, female gender, Hispanic ethnicity, cardiovascular disease, household income <$20,000, and marginal or inadequate health literacy predicted higher anxiety. Higher global COVID-19-related anxiety scores were associated with higher odds of reporting always wearing a mask in public (OR 1.30 (1.14, 1.48), p<0.001) and of eating less healthy foods (OR (95%CI) 1.29 (1.13, 1.46), p<0.001), reduced physical activity (OR 1.32 (1.20, 1.45), p<0.001), and weight gain (OR (1.23 (1.11, 1.38), p=0.001). Conclusion. Higher anxiety levels related to the COVID-19 pandemic were associated with higher self-reported adherence to mask wearing but also with higher weight gain and less adherence to healthy lifestyle behaviors. Interventions are needed to support continuation of healthy lifestyle behaviors in patients with CKD experiencing increased anxiety related to the pandemic.