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The C3 Study


Long-Term Impact of the COVID-19 Pandemic on Self-Management of Chronic Conditions: The C3 Study 


June 2022 - March 2027 

Funding Source:

National Institutes of Health (NIH)  

Grant Number:



COVID-19 has become an unprecedented public health threat in modern times, especially for older adults with a chronic illness. As of January 2021, 94% of COVID deaths have been among adults over 55; 92% of those who have died had ≥1 underlying health conditions. Beyond consequences to personal health associated with acquiring COVID-19, the impact of the pandemic may likely extend to non-COVID-19 outcomes as a patient’s ability to self-manage chronic conditions during and after a pandemic may be compromised for several reasons.  
First, multiple virus surges led state and local authorities to introduce community-wide restrictions that have limited or changed access to in-person healthcare services. Both clinicians and patients have had to quickly adapt to connecting remotely via telehealth platforms. There is now concern some patients may be ‘lost’ or inadequately monitored without routine collection of biometric health data. Second, fear of COVID-19 may also drive patients to avoid seeking medical care, even in acute circumstances. Third, recommended social distancing practices, and disruptions to daily routines may alter adults’ lifestyle (e.g. alcohol/substance use, physical activity, diet, sleep). Fourth, the pandemic has devastated the U.S. economy and many individuals’ socioeconomic circumstances - affecting healthcare coverage and access. Finally, cumulative stress, social isolation, grief and loss due to COVID-19 may have a sustained impact on mental health and well-being, the ability to adhere to treatment, self-manage chronic conditions, maintain functional status and achieve optimal health outcomes.


We will extend an active NIA cohort study of diverse, middle age and older adults with ≥1 chronic conditions to assess COVID-19’s long-term and disparate impact on health and healthcare experiences. 
In March 2020, our team rapidly launched the COVID-19 & Chronic Conditions (C3) study as cases of COVID-19 emerged in the U.S. to assess how adults with ≥1 chronic conditions were responding to the pandemic. Five active studies with uniform data collection on a range of patient-reported outcomes prior to COVID-19 and with electronic health records access were leveraged to establish the C3 cohort; 673 adults in Chicago were interviewed during the 1st week of the outbreak. The cohort was immediately expanded using two of the ‘parent studies’ that also had sites in New York City (n=200; N=873). C3 participants are diverse by socioeconomic status, race, ethnicity, gender, health literacy, and comorbidity. An NIA COVID-19 supplement was awarded in August 2020 to expand the cohort via the parent studies (N=1200) and continue data collection up to 2022; 8 of 8 planned survey waves have been completed (83-94% retention). C3 findings reveal many adults exhibit sustained, high stress due to COVID-19 that impacts lifestyle, treatment adherence, and healthcare use. Disparities by sex, race, ethnicity, and SES also are present. Health professionals and researchers are now voicing concern for possible long-term consequences of COVID-19 on personal health & healthcare.  
In response, we propose to continue to follow the C3 cohort to capture data 5 years post onset of the U.S. outbreak. All participants will have a ‘Pre-COVID’ baseline and up to 8 follow-up assessments to assess trajectories in health care use, patient-reported & chronic disease outcomes.  

Our primary aims are to:  
1) Evaluate changes in lifestyle, health behaviors, healthcare use, health status, and chronic disease outcomes from a pre-pandemic baseline through 5 years after onset of COVID-19. 
2) Determine the extent to which stress, anxiety, and depression contribute to poor health status and chronic disease outcomes through 5 years after the pandemic’s onset.   

Our secondary aim is to:  
3) Identify factors that mediate or moderate associations between stress, anxiety, and depression during/after the pandemic with health status and chronic disease outcomes.  

Our exploratory aim is to:  
4) Explore whether health disparities by age, sex, race, ethnicity, or socioeconomic status emerge or worsen during/after the pandemic and the contributing role of stress, anxiety, and depression. identifier:



• Principal Investigators: Michael S. Wolf, PhD MPH and Stacy Bailey, PhD MPH
• Project Lead: Sarah Filec