The SHOW COVID-19 cohort: methods and rationale for examining the statewide impact of COVID-19 on the social determinants of health

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Abstract Background National and large city mortality and morbidity data emerged during the early years of the COVID-19 pandemic, yet statewide data to assess the impact COVID-19 had across urban and rural landscapes on subpopulations was lacking. The SHOW COVID-19 cohort was established to provide descriptive and longitudinal data to examine the influence the social determinants of health had on COVID-19 related outcomes. Methods Participants were recruited from the 5,742 adults in the Survey of the Health of Wisconsin (SHOW) cohort who were all residents of Wisconsin, United States when they joined the cohort between 2008-2019. Online surveys were administered at three timepoints during 2020-2021. Survey topics included COVID-19 exposure, testing and vaccination, COVID-19 impact on economic wellbeing, healthcare access, mental and emotional health, caregiving, diet, lifestyle behaviors, social cohesion, and resilience. Results A total of 2,304 adults completed at least one COVID-19 online survey, with n=1,090 completing all three survey timepoints. Non-Whites were 2-3 times more likely to report having had COVID-19 compared to Whites, females were more likely than males to experience disruptions in their employment, and those with children in the home were more likely to report moderate to high levels of stress compared to adults without children. Conclusion Longitudinal, statewide cohorts are important for investigating how the social determinants of health affect people’s lives, health, and well-being during the first years of a pandemic and offer insight into future pandemic preparation. The data are available for researchers and cohort is active for continued and future follow-up. Key Messages Mortality and morbidity data emerged during the early years of the COVID-19 pandemic at the national scale and in large cities, yet comprehensive social, cultural, and economic population-level data at the state level was lacking for identifying sub-population trends. COVID-19 disrupted lives and affected people differently based on socio-economic status, demographics, family dynamics, geography, health status, and employment. SHOW COVID-19 cohort is a unique non-clinical, non-hospital-based sample with pre-COVID-19 baseline survey data and biospecimen and three waves of COVID-19 data and specimen available to examine effects of COVID-19 on the social determinants of health.

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