COVID-19 Infodemic and Health-Related Quality of Life in Patients with Chronic Respiratory Diseases: A Multicentre, Observational Study

Background: The explosion of information, misinformation, and disinformation (the ‘infodemic’) related to the coronavirus disease (COVID-19) pandemic on digital and social media is reported to affect mental health and quality of life. However, reports assessing the COVID-19 infodemic on health-related quality of life (HRQL) in patients with chronic diseases are scarce. Moreover, more than 545 million individuals currently live with chronic respiratory diseases (CRDs), but no study was conducted to assess the influence of this infodemic on the HRQL of these vulnerable populations. In this study, we investigated the associations between infodemic and HRQL in uninfected individuals with pre-existing CRDs such as asthma, chronic obstructive pulmonary disease (COPD), and other CRDs.Methods: We conducted a multi-national, cross-sectional, observational study in Canada, India, New Zealand, and the United Kingdom where we distributed a set of digitized questionnaires among 1,018 participants with chronic respiratory diseases who were not infected with the SARS-CoV-2 virus at least 3 months prior to the study. We collected information about the infodemic such as news watching or social media use more than usual during the pandemic. HRQL was assessed using the short form of the chronic respiratory questionnaire (SF-CRQ). We also collected information about their mental health, behavioural function, and social status using validated questionnaires along with demographic information, comorbidity, and compliance. We constructed structural equation models (SEM) to analyse the direct and indirect relationships between infodemic and HRQL taking into account mental health, behavioural function, and social status as mediators.Results: Of all participants, 54% were females and had a mean (standard deviation [SD]) age of 53 (17) years. We found that higher infodemic was associated with worse emotional function (regression coefficient β: -0ꞏ08; 95% confidence interval [CI]: -0ꞏ14 to -0ꞏ01), which means a 1 SD change of the higher infodemic latent variable was associated with a 0ꞏ08 SD change of emotional function level (e.g., 1 unit change in higher infodemic would decrease the mean emotional function value by 0ꞏ11 units). The association between higher infodemic and worse emotional function was mediated by worse mental health and behavioural functions but is marginally ameliorated by improved social status. In stratification analysis, we observed that the magnitude of the association between infodemic and emotional function was higher among participants with COPD than those with asthma. Although we did not observe any associations between infodemic and SF-CRQ domain scores after country-wise stratification, the directionality and magnitude of those associations varied significantly (p<0ꞏ001).Conclusions: These results provide new evidence that the COVID-19 infodemic significantly influences the HRQoL in patients with CRDs through a complex interplay between mental health, behavioural function, and social status. This new dimension of research also opens avenues for further research on infodemic-related health effects in other chronic diseases.Funding: The study was partially supported by Synergy Respiratory & Cardiac Care, CanadDeclaration of Interest: SM (Subhabrata Moitra) reports personal fees from Elsevier Inc. (USA), Synergy Respiratory & Cardiac Care (Canada), Permanyer Inc. (Spain); lecture fees from Apollo Gleneagles Hospital (India), and Institute of Allergy – Kolkata (India), outside the submitted work. FK reports grants from the Wellness of Workers (WoW) Program, Local 110 Heat & Frost Insulators & Allied Workers outside the present work. LM reports a grant from the Wellness of Workers (WoW) Program, Local 110 Heat & Frost Insulators & Allied Workers, outside the present work. NM reports non-financial support from GSK, non-financial support from AstraZeneca, non-financial support from Chiesi Farmaceutici, and non-financial support from Menarini, outside the submitted work. AS reports grants from the Health Research Council of New Zealand, outside the submitted work. AMT reports non- financial support from ResMed, during the conduct of the study; grants from National Institute of Health Research (United Kingdom); grants, personal fees, and non-financial support from AstraZeneca; grants and non-financial support from Chiesi; grants from Health Foundation, Alpha 1 Foundation, and ATS Foundation; personal fees and non-financial support from Boehringer Ingelheim, outside the submitted work. PL reports grants from the Wellness of Workers (WoW) Program, Local 110 Heat & Frost Insulators & Allied Workers, Synergy Respiratory Care Limited, AstraZeneca Canada, and the Natural Sciences and Engineering Research Council (NSERC) in Canada during the conduct of the study; and personal fees from AstraZeneca Canada and GSK Canada, outside the submitted work. Other authors do not have any conflict of interest to declare.Ethical Approval: The study was approved by ethics boards of respective centres; the Health Research Ethics Board of Alberta (HREBA.CHC-20-0056) and the Health Research Ethics Board of the University of Alberta (Pro00105432) (Canada). In New Zealand, and the United Kingdom, the study was was deemed out of scope for full ethical review, as per Health and Disability Ethics Committee guidelines, as the survey was anonymized. The study was completely anonymous and no personal information was obtained from the participants. A formal description of the study was provided in the digital survey and participants were asked to provide consent by selecting the ‘agree to participate’ option in the digital questionnaire.