{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T14:06:50Z","timestamp":1767794810667,"version":"3.49.0"},"reference-count":35,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T00:00:00Z","timestamp":1766707200000},"content-version":"unspecified","delay-in-days":178,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"NIH\/NHLBI","award":["R01HL157879"],"award-info":[{"award-number":["R01HL157879"]}]},{"name":"NIH\/NHLBI","award":["R01HL159805"],"award-info":[{"award-number":["R01HL159805"]}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["U01AG009740"],"award-info":[{"award-number":["U01AG009740"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Florida Independent Living Council, Inc.","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2025,11,10]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The COVID-19 pandemic disproportionately impacted the ageing population and persons with disability. Previous studies have used cross-sectional or descriptive designs, limiting the establishment of robust associations. Our objective was to examine prospective associations between functional disability and COVID-19 outcomes in ageing US adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study included 9390 Health and Retirement Study participants from the 2018 wave, representing 64\u2009044\u2009633 adults aged 50 years or older, who completed the 2021 Pandemic Mail-in Survey. Baseline functional disability comprised activities of daily living (ADL) and instrumental ADL. COVID-19 outcomes included infection, emergency room utilisation, hospitalisation, length of hospital stay and post-COVID conditions (PCC). Multivariate regression and propensity-score weighting were applied to assess prospective associations between baseline functional disability, vaccination and COVID-19 outcomes. Targeted learning was applied to assess the association between functional disability and COVID-19 within each vaccination stratum. Mediation analysis was used to quantify the proportion of effects of functional disability on COVID-19 infection and PCC, mediated through vaccination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>1460 (16.2%) participants reported infection, 7985 (86.1%) were vaccinated and 178 (11.4%) of COVID-19 infected had PCC. Functional disability was associated with increased risk of infection (OR: 1.28, 95%\u2009CI 1.01 to 1.64) and PCC (OR: 2.24, 95%\u2009CI 1.05 to 4.47), while vaccination was protective against infection (OR: 0.53, 95%\u2009CI 0.42 to 0.67). Vaccination mediated a small portion of the effect of functional disability on infection and PCC, while showing no effect modification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Comprehensive strategies beyond vaccination are needed to decrease infections and prevent PCC for vulnerable ageing adults with functional disability. As the first study to prospectively investigate associations between functional disability, vaccination status and COVID-19 outcomes using nationally representative data, these findings provide a robust foundation for future research and policy decisions to protect vulnerable populations during public health emergencies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-003116","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T05:15:13Z","timestamp":1766985313000},"page":"e003116","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Association of disability with COVID-19 outcomes in older adults: a prospective analysis of the US health and retirement study"],"prefix":"10.1136","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0021-029X","authenticated-orcid":false,"given":"Wenjie","family":"Zeng","sequence":"first","affiliation":[{"name":"Department of Medicine, Columbia University, New York, New York, USA"},{"name":"Department of Epidemiology, University of Florida, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9760-1659","authenticated-orcid":false,"given":"Inyoung","family":"Jun","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Florida, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2007-961X","authenticated-orcid":false,"given":"Rosha A","family":"Loach","sequence":"additional","affiliation":[{"name":"Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3937-6617","authenticated-orcid":false,"given":"Aryaman S","family":"Sriram","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Florida, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7993-9851","authenticated-orcid":false,"given":"Nichole E","family":"Stetten","sequence":"additional","affiliation":[{"name":"Brown University, Providence, Rhode Island, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3172-3132","authenticated-orcid":false,"given":"Panayiotis V","family":"Benos","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Florida, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8593-2090","authenticated-orcid":false,"given":"Nicole M","family":"Marlow","sequence":"additional","affiliation":[{"name":"Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,28]]},"reference":[{"key":"2026010703082040000_3.2.e003116.1","unstructured":"Centers for disease control and prevention, national center on birth defects and developmental disabilities, division of human development and disability . In: Disability and Health Data Systems (DHDS) Data. Available: https:\/\/dhds.cdc.gov"},{"key":"2026010703082040000_3.2.e003116.2","doi-asserted-by":"crossref","first-page":"100943","DOI":"10.1016\/j.dhjo.2020.100943","article-title":"The public health response to the COVID-19 pandemic for people with disabilities","volume":"13","author":"Boyle","year":"2020","journal-title":"Disabil Health J"},{"key":"2026010703082040000_3.2.e003116.3","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph18084348","article-title":"Health Risks and Consequences of a COVID-19 Infection for People with Disabilities: Scoping Review and Descriptive Thematic Analysis","volume":"18","author":"Kamalakannan","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2026010703082040000_3.2.e003116.4","doi-asserted-by":"crossref","unstructured":"Stevens A , Courtney-Long E , Gillespie C , et al . Hypertension among US adults by disability status and type. National Health and Nutrition Examination Survey 2001;11. doi:10.5888\/pcd11.140162","DOI":"10.5888\/pcd11.140162"},{"key":"2026010703082040000_3.2.e003116.5","doi-asserted-by":"publisher","DOI":"10.5888\/pcd11.130251"},{"key":"2026010703082040000_3.2.e003116.6","unstructured":"Taylor DM . Americans with disabilities: 2014. 2018."},{"key":"2026010703082040000_3.2.e003116.7","doi-asserted-by":"crossref","first-page":"791","DOI":"10.15585\/mmwr.mm7124a3","article-title":"COVID-19 Cases and Hospitalizations Among Medicare Beneficiaries With and Without Disabilities \u2014 United States, January 1, 2020\u2013November 20, 2021","volume":"71","author":"Yuan","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2026010703082040000_3.2.e003116.8","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.2105\/AJPH.2024.307794","article-title":"Long COVID Among People With Preexisting Disabilities","volume":"114","author":"Hall","year":"2024","journal-title":"Am J Public Health"},{"key":"2026010703082040000_3.2.e003116.9","doi-asserted-by":"crossref","first-page":"101436","DOI":"10.1016\/j.dhjo.2022.101436","article-title":"Post-COVID conditions and healthcare utilization among adults with and without disabilities-2021 Porter Novelli FallStyles survey","volume":"16","author":"Miller","year":"2023","journal-title":"Disabil Health J"},{"key":"2026010703082040000_3.2.e003116.10","doi-asserted-by":"crossref","unstructured":"Su H , Yang P-L , Eaton TL , et al . n.d. Cognition, function, and mood post-COVID-19: Comparative analysis using the health and retirement study. PLoS ONE 19:e0315425. doi:10.1371\/journal.pone.0315425","DOI":"10.1371\/journal.pone.0315425"},{"key":"2026010703082040000_3.2.e003116.11","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyu067"},{"key":"2026010703082040000_3.2.e003116.12","unstructured":"Health and retirement study: public survey data. 2025. Available: https:\/\/hrsdata.isr.umich.edu\/data-products\/public-survey-data"},{"key":"2026010703082040000_3.2.e003116.13","doi-asserted-by":"crossref","unstructured":"Agree EM , Wolf DA . Disability Measurement in the Health and Retirement Study. Forum Health Econ Policy 2017;21. doi:10.1515\/fhep-2017-0029","DOI":"10.1515\/fhep-2017-0029"},{"key":"2026010703082040000_3.2.e003116.14","doi-asserted-by":"crossref","unstructured":"Merrilees J . Activities of daily living. In: Encyclopedia of the neurological sciences. Academic Press, 2014.","DOI":"10.1016\/B978-0-12-385157-4.00464-4"},{"key":"2026010703082040000_3.2.e003116.15","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-044640","article-title":"Demographic risk factors for COVID-19 infection, severity, ICU admission and death: a meta-analysis of 59 studies","volume":"11","author":"Pijls","year":"2021","journal-title":"BMJ Open"},{"key":"2026010703082040000_3.2.e003116.16","unstructured":"Pew Research Center . Are you in the american middle class? find out with our income calculator. n.d. Available: https:\/\/www.pewresearch.org\/short-reads\/2020\/07\/23\/are-you-in-the-american-middle-class\/2020"},{"key":"2026010703082040000_3.2.e003116.17","doi-asserted-by":"crossref","first-page":"671","DOI":"10.2105\/AJPH.2023.307256","article-title":"Substance Use Among Asian American Adults in 2016-2020: A Difference-in-Difference Analysis of a National Survey on Drug Use and Health Data","volume":"113","author":"Yan","year":"2023","journal-title":"Am J Public Health"},{"key":"2026010703082040000_3.2.e003116.18","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1515\/jci-2014-0039","article-title":"Propensity Score Analysis with Survey Weighted Data","volume":"3","author":"Ridgeway","year":"2015","journal-title":"J Causal Inference"},{"key":"2026010703082040000_3.2.e003116.19","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12090"},{"key":"2026010703082040000_3.2.e003116.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2013.01.013"},{"key":"2026010703082040000_3.2.e003116.21","unstructured":"van Laan MJ , Rose S . Targeted Learning: Causal Inference for Observational and Experimental Data. Springer, 2011."},{"key":"2026010703082040000_3.2.e003116.22","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-018-0390-z"},{"key":"2026010703082040000_3.2.e003116.23","doi-asserted-by":"crossref","DOI":"10.2202\/1544-6115.1309","article-title":"Super learner","volume":"6","author":"van der Laan","year":"2007","journal-title":"Stat Appl Genet Mol Biol"},{"key":"2026010703082040000_3.2.e003116.24","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v059.i09"},{"key":"2026010703082040000_3.2.e003116.25","doi-asserted-by":"publisher","DOI":"10.7326\/M16-2607"},{"key":"2026010703082040000_3.2.e003116.26","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-020-2521-4"},{"key":"2026010703082040000_3.2.e003116.27","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1136\/bmjebm-2020-111426","article-title":"COVID-19 and the US response: accelerating health inequities","volume":"26","author":"Okonkwo","year":"2020","journal-title":"BMJ Evid Based Med"},{"key":"2026010703082040000_3.2.e003116.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.dhjo.2020.100969"},{"key":"2026010703082040000_3.2.e003116.29","doi-asserted-by":"crossref","unstructured":"Olulana O , Abedi V , Avula V , et al . Regional Association of Disability and SARS-CoV-2 Infection in 369 Counties of the United States. medRxiv 2020. doi:10.1101\/2020.06.24.20139212","DOI":"10.1101\/2020.06.24.20139212"},{"key":"2026010703082040000_3.2.e003116.30","doi-asserted-by":"crossref","first-page":"102359","DOI":"10.1016\/j.msard.2020.102359","article-title":"Adherence to social distancing and use of personal protective equipment and the risk of SARS-CoV-2 infection in a cohort of patients with multiple sclerosis","volume":"45","author":"Landi","year":"2020","journal-title":"Mult Scler Relat Disord"},{"key":"2026010703082040000_3.2.e003116.31","article-title":"Duration of SARS-CoV-2 shedding and infectivity in the working age population: a systematic review and meta-analysis","volume":"113","author":"Rahmani","year":"2022","journal-title":"Med Lav"},{"key":"2026010703082040000_3.2.e003116.32","doi-asserted-by":"publisher","DOI":"10.1177\/00333549211058733"},{"key":"2026010703082040000_3.2.e003116.33","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7039a2"},{"key":"2026010703082040000_3.2.e003116.34","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2023.1217843","article-title":"Occupational outcomes of people with multiple sclerosis during the COVID-19 pandemic: a systematic review with meta-analysis","volume":"11","author":"Vitturi","year":"2023","journal-title":"Front Public Health"},{"key":"2026010703082040000_3.2.e003116.35","doi-asserted-by":"crossref","unstructured":"Kompaniyets L , Bull-Otterson L , Boehmer TK , et al . Post-COVID-19 Symptoms and Conditions Among Children and Adolescents - United States. Aug 2020;71. doi:10.15585\/mmwr.mm7131a3","DOI":"10.15585\/mmwr.mm7131a3"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2025-003116","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T11:11:44Z","timestamp":1767784304000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2025-003116"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":35,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,12,28]]},"published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1136\/bmjph-2025-003116"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2025-003116","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7]]}}}