System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Research Support, Non-U.S. Gov't Epublish 4 citations

PubMed: 38296292 DOI: 10.1136/bmjopen-2023-078135

Risk factor associations for severe COVID-19, influenza and pneumonia in people with diabetes to inform future pandemic preparations: UK population-based cohort study.

BMJ Open 14(1):e078135

Authors: Rhian Hopkins, Katherine G Young, Nicholas J Thomas, James Godwin, Daniyal Raja, Bilal A Mateen, Robert J Challen, Sebastian J Vollmer, Beverley M Shields, Andrew P McGovern, John M Dennis

Affiliations

  • Institute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, UK.
  • Institute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, UK.
  • The Alan Turing Institute, London, UK.
  • Institute of Health Informatics, University College London, London, UK.
  • Engineering Mathematics, University of Bristol, Bristol, UK.
  • NIHR Applied Research Collaboration South West Peninsula, Exeter, UK.
  • Department of Statistics, University of Warwick, Coventry, UK.

Abstract

OBJECTIVE

This study aimed to compare clinical and sociodemographic risk factors for severe COVID-19, influenza and pneumonia, in people with diabetes.

DESIGN

Population-based cohort study.

SETTING

UK primary care records (Clinical Practice Research Datalink) linked to mortality and hospital records.

PARTICIPANTS

Individuals with type 1 and type 2 diabetes (COVID-19 cohort: n=43 033 type 1 diabetes and n=584 854 type 2 diabetes, influenza and pneumonia cohort: n=42 488 type 1 diabetes and n=585 289 type 2 diabetes).

PRIMARY AND SECONDARY OUTCOME MEASURES

COVID-19 hospitalisation from 1 February 2020 to 31 October 2020 (pre-COVID-19 vaccination roll-out), and influenza and pneumonia hospitalisation from 1 September 2016 to 31 May 2019 (pre-COVID-19 pandemic). Secondary outcomes were COVID-19 and pneumonia mortality. Associations between clinical and sociodemographic risk factors and each outcome were assessed using multivariable Cox proportional hazards models. In people with type 2 diabetes, we explored modifying effects of glycated haemoglobin (HbA1c) and body mass index (BMI) by age, sex and ethnicity.

RESULTS

In type 2 diabetes, poor glycaemic control and severe obesity were consistently associated with increased risk of hospitalisation for COVID-19, influenza and pneumonia. The highest HbA1c and BMI-associated relative risks were observed in people aged under 70 years. Sociodemographic-associated risk differed markedly by respiratory infection, particularly for ethnicity. Compared with people of white ethnicity, black and south Asian groups had a greater risk of COVID-19 hospitalisation, but a lesser risk of pneumonia hospitalisation. Risk factor associations for type 1 diabetes and for type 2 diabetes mortality were broadly consistent with the primary analysis.

CONCLUSIONS

Clinical risk factors of high HbA1c and severe obesity are consistently associated with severe outcomes from COVID-19, influenza and pneumonia, especially in younger people. In contrast, associations with sociodemographic risk factors differed by type of respiratory infection. This emphasises that risk stratification should be specific to individual respiratory infections.

MeSH

Diabetes Mellitus, Mortality, Cohort Studies, Respiratory Tract Infections, Electronic Health Records, Covid-19, Pneumonia, Influenza, Human, Obesity, Risk Factors, Pandemics, Records, Obesity, Morbid, Diabetes Mellitus, Type 1, Infections, Diabetes Mellitus, Type 2

Cited by