key: cord-0957306-7fouwxy1
authors: Dye, T.; Levandowski, B.; Li, D.; Wiltse, S.; Muir, E.; Pérez Ramos, J.; Siddiqi, S.; Sharma, S.; Royzer, R.; Panko, T.; Hall, W.; Irvine, C.; Pressman, E.
title: Multilevel Analysis of Personal, Non-Medical COVID-19-Related Impact Worldwide
date: 2020-09-26
journal: Ann Epidemiol
DOI: 10.1016/j.annepidem.2020.08.060
sha: b14f4690b98d9a712d0be41e9742f06bfc7c5b72
doc_id: 957306
cord_uid: 7fouwxy1

nan

Purpose: To identify associations of non-medical COVID-19-related impact on individuals by region of the world. Methods: We conducted a cross-sectional, multi-leveled study worldwide (n¼7411) recruited through Facebook and Amazon's mTURK assessing COVID-19 experiences, efforts to prevent it, and associated issues. We constructed a novel non-medical COVID-19 Impact Score (nmCIS) from 14 non-medical items in four domains (livelihood, cancelations, supplies, personal actions) converted to standardized T-scores (mean: 50; SD: 10). GEE models with normal distribution assumption and identity link function were used for data analyses to determine association of individual, household, and country-level variables on nmCIS. 20.8% to household factors, and 17% to country-level factors. Social factors (53.8% of nmCIS variation) and biological factors (28.1% of nmCIS variation) were more prominent than healthcare (3.7%) or abiotic (14.4%) factors. Country-level variables accounted for more nmCIS variation in Africa (41.3%) and Asia (32.8%) than in other regions and biological factors accounted for more nmCIS variation in Northern America (62.3%). Except in Oceania, country-level COVID-19 morbidity/ mortality metrics remained insignificant predictors of non-medical impact after multilevel modeling. Conclusions: Individual-level sociocultural variables (representing social roles, power dynamics, and stressors) were most strongly associated with nmCIS in most regions of the world. Country-level impact on nmCIS globally (especially in Africa and Asia) demonstrates the complex effect of social conditions, country policy, and environmental factors on individual experience, which needs further exploration to help prevent unintended consequences of COVID-19 control. Funding: Mae Stone Goode Foundation. 9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  36  37  38  39  40  41  42  43  44  45  46  47  48  49  50  51  52  53  54 55

Multilevel Analysis of Personal, Non-Medical COVID-19-Related Impact Worldwide