Chronic disease through the lens of COVID-19

Gayenell Magwood, Ph.D., a professor in the MUSC College of Nursing, has received more than $3.4 million in funding from the National Institute of Nursing Research (NINR) to investigate how COVID-19 has affected the health and quality of life of Black South Carolinians with preexisting chronic conditions and their caregivers. The funded research will also explore whether stressors related to structural inequities and racial discrimination affect COVID-19 and chronic disease outcomes. 

“We want to explore what happens in a pandemic with people of color and their chronic conditions and what role economic and societal stressors and structural racial inequities play,” said Magwood.

COVID-19 and chronic disease

It has long been known that chronic conditions, such as high blood pressure, diabetes and obesity, increase the risk of stroke, heart disease and cancer. But fear of a consequence in the distant future often did not bring about needed behavior and lifestyle changes.

"We want to explore what happens in a pandemic with people of color and their chronic conditions and what role economic and societal stressors and structural racial inequities play."

-- Dr. Gayenell Magwood

COVID-19 changed that time frame. It preyed preferentially on people with some of these chronic diseases, increasing their risks of developing and/or dying from severe COVID-19.

According to a study by the Centers for Disease Control and Prevention (CDC), more than a half million patients were hospitalized with COVID-19 between March of 2020 and March of 2021. Of those patients, 95% had at least one underlying medical condition, roughly half had either high blood pressure or disorders of lipid metabolism and a third were obese. The study found a strong association between obesity and diabetes, both of which are widespread in the U.S., and severe COVID-19 disease. The study also found that having more than one underlying condition increased the likelihood of developing severe COVID-19.

Chronic disease in South Carolina

South Carolina is certainly no stranger to chronic disease. The South Carolina Department of Public Health and Environmental Control (SCDHEC) estimates that six in 10 South Carolinians have a chronic illness and four in ten have two or more. According to the CDC, more than one in three South Carolinians (36%) identified as obese in 2020, and the state ranked sixth for highest percentage of adults with diabetes in 2019.

Although South Carolinians of every race are affected by chronic disease, Black communities are hit particularly hard. Non-Hispanic Black adults have twice the death rate and higher rates of obesity than non-Hispanic white adults (43.9% versus 32.4%), according to 2018-2020 SCDHEC data. This higher burden of chronic disease was one factor that caused Black people to be more vulnerable to developing severe COVID-19.

Engaging the community

But were other factors also responsible for the toll COVID-19 took on Black communities? Did structural inequities in access to information and care and chronic stress due to racial discrimination also play a role? And how did the pandemic affect the management of existing chronic disease in underserved communities?

With the funding from NINR, Magwood will engage underserved communities in answering these questions using a community-engaged approach. She and her team previously used a community-based participatory approach to encourage diverse participation in an earlier WISSDOM (Wide Spectrum Investigation of Stroke Outcome Disparities on Multiple Levels) stroke trial. In a recent article in Contemporary Clinical Trial Communications, she outlined this high-tech, high-touch approach to recruiting diverse clinical trial participants.

"It’s important that we show cultural humility, that we take the time to understand what a community’s priorities may be instead of coming in as if we already know what is best for them.”

-- Dr. Gayenell Magwood

While technology, whether in the form of the electronic health record or a stroke registry, helped to identify potential clinical trial participants, it was the human touch that mattered in the end. Stroke patients were more likely to participate in trials or adhere to stroke management guidelines when the study team took the time to listen to them and learn about their concerns through focus groups and interviews.

For the NINR project, Magwood will again turn to focus groups and interviews to learn whether societal inequities and racial discrimination have affected chronic disease and COVID-19 outcomes in Black adults in South Carolina. And she will bring to the new project insights gained from the previous trial.

“It’s important that we show cultural humility, that we take the time to understand what a community’s priorities may be instead of coming in as if we already know what is best for them,” said Magwood.

Armed with the information gained from focus groups, Magwood’s team will then tailor  strategies to address the concerns of underserved communities to ensure that they are better prepared to weather future pandemics.

Taking a family approach

Magwood believes that too many interventions meant to improve chronic disease management have focused too narrowly on the individual patient and ignored the role played by, and the pressures put upon, the family.

"Over the years of experience that I've had working with chronic disease prevention and management and with communities, I’ve been told over and over again by caregivers, ‘I wish I could help my brother,’ or ‘I wish I could help my husband/wife more, but I have my own health problems,’” said Magwood. “So we're bringing people – the patients and their care partners -- together to help them to co-manage their chronic illnesses.”

Her team will try to find the best approach for improving quality-of-life and health outcomes for both patients and their care partners. They will examine whether coaching alone, using the tailored educational models, or coaching plus nurse guidance in navigating the health care system results in the best outcomes.

References

Kompaniyets L, Pennington AF, Goodman AB, Rosenblum HG, Belay B, Ko JY, Chevinsky JR, Schieber LZ, Summers AD, Lavery AM, Preston LE, Danielson ML, Cui Z, Namulanda G, Yusuf H, Mac Kenzie WR, Wong KK, Baggs J, Boehmer TK, Gundlapalli AV. Underlying Medical Conditions and Severe Illness Among 540,667 Adults Hospitalized With COVID-19, March 2020-March 2021. Prev Chronic Dis. 2021 Jul 1;18:E66. doi: 10.5888/pcd18.210123. PMID: 34197283; PMCID: PMC8269743.

Magwood GS, Ellis C, Buie JNJ, Slan S, Bonilha L, Adams RJ. High tech and high touch: Recruitment strategies for enrolling African American stroke survivors in Community Based Intervention under Nurse Guidance after stroke (CINGS) trial. Contemp Clin Trials Commun. 2021 Sep 8;24:100844. doi: 10.1016/j.conctc.2021.100844.