{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:38:01Z","timestamp":1787017081020,"version":"build-2736575974"},"reference-count":56,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"unspecified","delay-in-days":78,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","award":["Not Applicable"],"award-info":[{"award-number":["Not Applicable"]}],"id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,4,30]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Immunocompromised individuals have suboptimal COVID-19 vaccine responses and may continue physically distancing to avoid COVID-19. The EAGLE Study aimed to quantify physical distancing behaviours and associations with health-related quality of life (HRQoL) and related measures in immunocompromised adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>EAGLE was a cross-sectional, observational online survey study of US and UK immunocompromised adults, children and those children\u2019s caregivers, with adult analyses reported here. Multichannel enrolment and self-reported data collection occurred from December 2022 to June 2023. Immunocompromising diagnosis confirmation using medical records was requested from a randomly selected subset. Physical distancing (in past 4 weeks) was measured using the Physical Distancing Scale for COVID-19 Avoidance (PDS-C19). HRQoL and related measures were the 12-item Short Form Health Survey version 2 (SF-12v2) (includes Short-Form 6-Dimensions), Quality of Life Disease Impact Scale-7-item (QDIS-7), Direct Measure of Loneliness, EQ-5D-5L, Hospital Anxiety and Depression Scale and Work Productivity and Activity Impairment plus Classroom Impairment Questions: Specific Health Problem (WPAI+CIQ:SHP). Associations between PDS-C19 and HRQoL and related measures were assessed using Pearson correlation, linear regression (potential confounders-adjusted) and preliminary structural equation modelling (SEM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>2320 immunocompromised adults fully completed the survey. Confirmation of diagnosis was requested from 27% and confirmed for 90% of responders. 68% of participants reported moderate to high physical distancing. Physical distancing had low correlations with SF-12v2-measured HRQoL domains (range |r|=0.18\u2009to 0.39)\u2009and medium correlations with QDIS-7 (r=0.78) and WPAI+CIQ:SHP-measured activity impairment (r=0.68) and presenteeism (r=0.51). In SEM, direct PDS-C19 relationships explained most activity correlations: QDIS, \u03b2=0.46 (SE=0.02); activity impairment, \u03b2=0.40 (0.02); presenteeism, \u03b2=0.29 (0.04). Unstandardised PDS-C19 confounder-adjusted linear regression coefficients were similar to those of SEM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Over 3 years after COVID-19 emergence, a disproportionate number of immunocompromised adults reported substantially physically distancing to avoid COVID-19. Higher physical distancing intensities were associated with greater HRQoL impairments, suggesting such challenges coexist as ongoing concerns for immunocompromised adults.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2024-001865","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T10:45:18Z","timestamp":1781779518000},"page":"e001865","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Assessing the association of physical distancing to avoid COVID-19 with health-related quality of life in immunocompromised adults: results from the cross-sectional observational EAGLE study"],"prefix":"10.1136","volume":"4","author":[{"given":"Paul","family":"Williams","sequence":"first","affiliation":[{"name":"IQVIA, Courbevoie, France"},{"name":"Global Evidence, BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3475-8616","authenticated-orcid":false,"given":"Timothy A","family":"Herring","sequence":"additional","affiliation":[{"name":"Medical Evidence, Epidemiology, Vaccine & Immune Therapies, BioPharmaceuticals Medical, AstraZeneca US, Wilmington, Delaware, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata T C","family":"Yokota","sequence":"additional","affiliation":[{"name":"Epidemiology & Pharmacovigilance, P95, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2093-5781","authenticated-orcid":false,"given":"Sudhir","family":"Venkatesan","sequence":"additional","affiliation":[{"name":"BPM Evidence Statistics, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7624-0091","authenticated-orcid":false,"given":"Sofie","family":"Arnetorp","sequence":"additional","affiliation":[{"name":"Health Economic & Payer Evidence, BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9590-0244","authenticated-orcid":false,"given":"Johan L","family":"Severens","sequence":"additional","affiliation":[{"name":"Severens HTA Consultancy, Venray, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1169-3431","authenticated-orcid":false,"given":"Philip A","family":"Powell","sequence":"additional","affiliation":[{"name":"SCHARR, University of Sheffield, Sheffield, UK"},{"name":"Philip A Powell Consulting, Sheffield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5223-4173","authenticated-orcid":false,"given":"James C","family":"Marcus","sequence":"additional","affiliation":[{"name":"IQVIA, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Philpott","sequence":"additional","affiliation":[{"name":"IQVIA, Reading, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Bestea","sequence":"additional","affiliation":[{"name":"IQVIA, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey M","family":"Rohay","sequence":"additional","affiliation":[{"name":"IQVIA, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiago","family":"Maia","sequence":"additional","affiliation":[{"name":"IQVIA, Porto Salvo, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia","family":"Taylor","sequence":"additional","affiliation":[{"name":"Medical Evidence, Vaccine & Immune Therapies, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marieke","family":"Krol","sequence":"additional","affiliation":[{"name":"IQVIA, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"John E","family":"Ware","sequence":"additional","affiliation":[{"name":"John Ware Research Group, Watertown, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"2026061803451314000_4.2.e001865.1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.o524","article-title":"Covid-19: CDC relaxes rules on mask wearing","volume":"376","author":"Tanne","year":"2022","journal-title":"BMJ"},{"key":"2026061803451314000_4.2.e001865.2","unstructured":"Gov.UK Cabinet Office . 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