Gayenell Magwood, Ph.D., of the Medical University of South Carolina (MUSC) has received more than $3.4 million in funding from the National Institute of Nursing Research (NINR) to investigate how COVID-19 has affected the health and quality of life of Black South Carolinians with preexisting chronic conditions and their caregivers. The funded research will also explore whether stressors related to structural inequities and racial discrimination affect COVID-19 and chronic disease outcomes. Magwood is a professor in the MUSC College of Nursing.
“We want to explore what happens in a pandemic with people of color and their chronic conditions and what role economic and societal stressors and structural racial inequities play,” said Magwood.
COVID-19 and chronic disease
It has long been known that chronic conditions, such as high blood pressure, diabetes and obesity, increase the risk of stroke, heart disease and cancer. But fear of a consequence in the distant future often did not bring about needed behavior and lifestyle changes.
COVID-19 changed that time frame. It preyed preferentially on people with some of these chronic diseases, increasing their risks of developing and/or dying from severe COVID-19.
According to a study by the Centers for Disease Control and Prevention (CDC), more than a half million patients were hospitalized with COVID-19 between March of 2020 and March of 2021. Of those patients, 95% had at least one underlying medical condition, roughly half had either high blood pressure or disorders of lipid metabolism and a third were obese. The study found a strong association between obesity and diabetes, both of which are widespread in the U.S., and severe COVID-19 disease. The study also found that having more than one underlying condition increased the likelihood of developing severe COVID-19.
Chronic disease in South Carolina
South Carolina is certainly no stranger to chronic disease. The South Carolina Department of Public Health and Environmental Control (SCDHEC) estimates that six in 10 South Carolinians have a chronic illness and four in ten have two or more. According to the CDC, more than one in three South Carolinians (36%) identified as obese in 2020, and the state ranked sixth for highest percentage of adults with diabetes in 2019.
Although South Carolinians of every race are affected by chronic disease, Black communities are hit particularly hard. Non-Hispanic Black adults have twice the death rate and higher rates of obesity than of non-Hispanic white adults (43.9% versus 32.4%), according to 2018-2020 SCDHEC data. This higher burden of chronic disease was one factor that caused Black people to be more vulnerable to developing severe COVID-19.
Engaging the community
But were other factors also responsible for the toll COVID-19 took on Black communities? Did structural inequities in access to information and care and chronic stress due to racial discrimination also play a role? And how did the pandemic affect the management of existing chronic disease in underserved communities?
With the funding from NINR, Magwood will engage underserved communities in answering these questions using a community-engaged approach. With funding support from the South Carolina Clinical & Translational Research Institute, she and her team previously used a community-based participatory approach to encourage diverse participation in a WISSDOM (Wide Spectrum Investigation of Stroke Outcome Disparities on Multiple Levels) stroke trial. In an article in the December issue of Contemporary Clinical Trials Communications, she outlined this high-tech, high-touch approach to recruiting diverse clinical trial participants. While technology, whether in the form of the electronic health record or a stroke registry, helped to identify potential clinical trial participants, it was the human touch that mattered in the end. Stroke patients were more likely to participate in trials or adhere to stroke management guidelines when the study team took the time to listen to them and learn about their concerns through focus groups and interviews.
For the NINR project, Magwood will again turn to focus groups and interviews to learn whether societal inequities and racial discrimination have affected chronic disease and COVID-19 outcomes in Blacks in South Carolina. And she will bring to the new project insights gained from the previous trial.
“It’s important that we show cultural humility, that we take the time to understand what a community’s priorities may be instead of coming in as if we already know what is best for them,” said Magwood.
Armed with the information gained from focus groups, Magwood’s team will then tailor strategies to address the concerns of underserved communities to ensure that they are better prepared to weather future pandemics.
Taking a family approach
Magwood believes that too many interventions meant to improve chronic disease management have focused too narrowly on the individual patient and ignored the role played by, and the pressures put upon, the family.
“Over the years of experience that I've had working with chronic disease prevention and management and with communities, I’ve been told over and over again by caregivers, ‘I wish I could help my brother,’ or ‘I wish I could help my husband/wife more, but I have my own health problems,’” said Magwood. “So we're bringing people – the patients and their care partners together to help them to co-manage their chronic illnesses.”
Her team will try to find the best approach for improving quality-of-life and health outcomes for both patients and their caregivers. They will examine whether coaching alone, using the tailored educational models, or coaching plus nurse guidance in navigating the health care system results in the best outcomes.
Founded in 1824 in Charleston, MUSC is the oldest medical school in the South as well as the state's only integrated academic health sciences center with a unique charge to serve the state through education, research and patient care. Each year, MUSC educates and trains more than 3,000 students and nearly 800 residents in six colleges: Dental Medicine, Graduate Studies, Health Professions, Medicine, Nursing and Pharmacy. The state's leader in obtaining biomedical research funds, in fiscal year 2019, MUSC set a new high, bringing in more than $284 million. For information on academic programs, visit musc.edu.
As the clinical health system of the Medical University of South Carolina, MUSC Health is dedicated to delivering the highest quality patient care available while training generations of competent, compassionate health care providers to serve the people of South Carolina and beyond. Comprising some 1,600 beds, more than 100 outreach sites, the MUSC College of Medicine, the physicians' practice plan and nearly 275 telehealth locations, MUSC Health owns and operates eight hospitals situated in Charleston, Chester, Florence, Lancaster and Marion counties. In 2020, for the sixth consecutive year, U.S. News & World Report named MUSC Health the No. 1 hospital in South Carolina. To learn more about clinical patient services, visit muschealth.org.
MUSC and its affiliates have collective annual budgets of $3.2 billion. The more than 17,000 MUSC team members include world-class faculty, physicians, specialty providers and scientists who deliver groundbreaking education, research, technology and patient care.
About the SCTR Institute
The South Carolina Clinical & Translational Research (SCTR) Institute is the catalyst for changing the culture of biomedical research, facilitating the sharing of resources and expertise and streamlining research-related processes to bring about large-scale change in the clinical and translational research efforts in South Carolina. Our vision is to improve health outcomes and quality of life for the population through discoveries translated into evidence-based practice. To learn more, visit https://research.musc.edu/resources/sctr