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

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 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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by the Wisconsin Partnership Program (WPP) PERC Award [233 PRJ 25DJ and WPP4444]. WPP supports efforts to improve the health of the people of Wisconsin by supporting partnerships between the University of Wisconsin School of Medicine and Public Health and local, regional, and statewide groups to address the most important health issues in Wisconsin. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the University of Wisconsin-Madison Health Sciences Institutional Review Board [2013-0251-CP132]. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The SHOW COVID-19 study investigators encourage use of COVID-19 Survey data and stored biospecimen for future grants and publications. Limited use data from all waves of the COVID-19 Survey is free and publicly available. Access to complete survey data from COVID-19 Survey, and access to baseline SHOW survey data, are subject to fee-for-service charges available for use via a data request process. The SHOW study investigators encourage collaboration and use of the SHOW COVID-19 cohort, data, and stored biospecimen for future grants and publications. Participants in the SHOW COVID-19 cohort have consented to be contacted for future follow-up studies and SHOW study investigators are available to assist researchers interested in following up the cohort and expanding data collection. For those interested in using the data, or leveraging SHOW COVID-19 cohort or SHOW cohort for ancillary studies, contact the corresponding author or visit the SHOW website: https://show.wisc.edu/