Association between Risk Factors for Complications from COVID-19, Perceived Chances of Infection and Complications, and Protective Behavior in the US

Importance: It is unknown whether adults who are susceptible to severe complications from COVID-19 recognize their susceptibility and modify behavior to reduce exposure. Objective: To determine whether adults with risk factors for COVID-19 complications perceive an elevated chance of complications and undertake fewer higher infection risk behaviors. Design, Setting, and Participants: This cross-sectional analysis, adjusted for sociodemographic characteristics, included civilian noninstitutionalized US adults of wave 18 of the Understanding America Study collected from November 11 to December 9, 2020. Exposures: US Centers for Disease Control and Prevention-identified medical risk factors for COVID-19 complications and older age. Main Outcomes and Measures: Primary outcomes were perceived percentage chance of infection and hospitalization and death if infected; whether 9 potentially higher infection risk activities were undertaken in the past week and, if so, whether a mask was worn; whether a mask was worn anywhere in the past week; and attitudes toward 12 aspects of mask wearing. Results: In Understanding America Study wave 18 (n = 5910 participants with nonmissing data), the mean age was 48 years, and 52% were women. The response rate was 77%. Adults with 7 of 9 medical risk factors and aged 70 years and older reported a higher perceived chance of complications if infected. Adjusted mean perceived chance of hospitalization if infected ranged from 23.9% (95% CI, 22.2%-25.5%) for those with high blood pressure to 40.4% (95% CI, 34.6%-46.2%) for those with chronic lung disease and was associated with number of medical risk factors: 17.6% (95% CI, 16.4%-18.8%) and 41.8% (95% CI, 38.7%-45.0%) for adults with 0 vs 3 or more medical risk factors, respectively. Fewer potentially higher infection risk activities were undertaken by adults with 3 or more vs 0 risk factors: 2.83 (95% CI, 2.66-2.99) vs 3.12 (95% CI, 3.02-3.22). Wearing a mask sometime last week was nearly universal (90.1%). But during only 1 specific activity (visiting a grocery store or pharmacy) did more than half always wear a mask, and for only 1 activity (visiting a grocery store or pharmacy) was mask wearing more common among adults with 3 or more vs 0 conditions. Conclusions and Relevance: In this cross-sectional survey study, adults with risk factors for COVID-19 complications reported higher perceived susceptibility to complications. During common activities, including visiting with friends, the majority of adults, including the highly susceptible, did not consistently wear masks.