Long-term behavioral changes during the COVID-19 pandemic and impact of vaccination in patients with inflammatory rheumatic diseases

OBJECTIVE: To explore anxiety and self-isolation 15 months into the COVID-19 pandemic including attitudes towards and impact of SARS-CoV-2 vaccination in patients with inflammatory rheumatic disease (IRD).

METHODS: Nationwide online survey at three time points (May 2020, November 2020, May 2021). Patients with IRD followed in the Danish DANBIO registry were asked about the impact of the pandemic (SARS-CoV-2-infection, behavior, anxiety, concerns). The May 2021-survey included attitudes towards vaccination (SARS-CoV-2, influenza). Characteristics associated with self-isolation in May 2021 were explored with adjusted logistic-regression analyses including patient characteristics and SARS-CoV-2-vaccination status.

RESULTS: Respondents to survey 1, 2 and 3 were 12789, 14755 and 13921 patients, respectively (64% rheumatoid arthritis, 63% female). Anxiety and concerns were highest in May 2020 and decreased to stable levels in November 2020 and May 2021 (86%, 50% and 52% reported self-isolation, respectively). In May 2021, self-reported previous SARS-CoV-2-infection was 4%. SARS-CoV-2 vaccine acceptance was 86%, and proportions of influenza-vaccinated patients had increased (50% winter 2019-20 to 64% in 2020-21). Proportions with anxiety appeared similar in SARS-CoV-2 vaccinated and unvaccinated. In multivariable analyses, being unvaccinated, female gender, receiving biologicals, and poor quality of life were independently associated with self-isolation.

CONCLUSION: Levels of anxiety and self-isolation decreased after the initial lock-down period in patients with IRD. Half of patients reported self-isolation in May 2021, -a phase with wide-spread re-opening of society and large-scale vaccination. Lack of pre-pandemic data prevented a full understanding of the long-term impact of the pandemic on anxiety and self-isolation in IRDs.