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Abstract
This longitudinal study aimed to assess the impact of COVID-19 containment measures on perceived health, health protective behavior and risk perception, and investigate whether chronic disease status and urbanicity of the residential area modify these effects. Participants (n = 5420) were followed for up to 14 months (September 2020-October 2021) by monthly questionnaires. Chronic disease status was obtained at baseline. Urbanicity of residential areas was assessed based on postal codes or neighborhoods. Exposure to containment measures was assessed using the Containment and Health Index (CHI). Bayesian multilevel-models were used to assess effect modification of chronic disease status and urbanicity by CHI. CHI was associated with higher odds for worse physical health in people with chronic disease (OR = 1.09, 95% credibility interval (CrI) = 1.01, 1.17), but not in those without (OR = 1.01, Crl = 0.95, 1.06). Similarly, the association of CHI with higher odds for worse mental health in urban dwellers (OR = 1.31, Crl = 1.23, 1.40) was less pronounced in rural residents (OR = 1.20, Crl = 1.13, 1.28). Associations with behavior and risk perception also differed between groups. Our study suggests that individuals with chronic disease and those living in urban areas are differentially affected by government measures put in place to manage the COVID-19 pandemic. This highlights the importance of considering vulnerable subgroups in decision making regarding containment measures.
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1 Utrecht University, Institute for Risk Assessment Sciences (IRAS), Utrecht, The Netherlands (GRID:grid.5477.1) (ISNI:0000 0001 2034 6234)
2 National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, Utrecht, The Netherlands (GRID:grid.31147.30) (ISNI:0000 0001 2208 0118)
3 University of Groningen, University Medical Center Groningen, Beatrix Children’s Hospital, Department of Paediatric Pulmonology and Paediatric Allergology, Groningen, The Netherlands (GRID:grid.4494.d) (ISNI:0000 0000 9558 4598); University of Groningen, University Medical Center Groningen, Groningen Research Institute of Asthma and COPD (GRIAC), Groningen, The Netherlands (GRID:grid.4494.d) (ISNI:0000 0000 9558 4598)
4 University of Groningen, University Medical Center Groningen, Groningen Research Institute of Asthma and COPD (GRIAC), Groningen, The Netherlands (GRID:grid.4494.d) (ISNI:0000 0000 9558 4598); University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands (GRID:grid.4494.d) (ISNI:0000 0000 9558 4598)
5 Utrecht University, Institute for Risk Assessment Sciences (IRAS), Utrecht, The Netherlands (GRID:grid.5477.1) (ISNI:0000 0001 2034 6234); University Medical Centre Utrecht, Julius Centre for Health Sciences and Primary Care, Utrecht, The Netherlands (GRID:grid.7692.a) (ISNI:0000 0000 9012 6352)