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Type 1 and Type 2 Diabetes and COVID-19 Related Mortality in England: A Whole Population Study
26 Pages Posted: 19 Jun 2020More...
Background: Although diabetes has been associated with COVID-19 mortality, the absolute and relative risks for Type 1 and Type 2 diabetes are unknown.
Methods: A population cohort study assessing risks of in-hospital death with COVID-19 between 1st March and 11th May 2020, including individuals registered with a General Practice in England and alive on February 19th 2020. Multivariate logistic regression examined diabetes status, by type, and associations with in-hospital death, adjusting for demographic factors and comorbidities.
Findings: Of the 61,414,470 individuals registered, 263,830 (0∙4%) had a recorded diagnosis of Type 1 and 2,864,670 (4∙7%) of Type 2 diabetes. There were 23,804 COVID-19 related deaths. One third occurred in people with diabetes: 7,466 (31∙4%) with Type 2 and 365 (1∙5%) with Type 1 diabetes. Crude mortality rates per 100,000 persons over the 72 days for the overall population and for those with Type 1 and Type 2 diabetes were 38∙8 (38∙3-39∙3), 138∙3 (124∙5-153∙3), and 260∙6 (254∙7-266∙6) respectively. Adjusted for age, sex, deprivation, ethnicity and geographical region, people with Type 1 and Type 2 diabetes had 3∙50 (3∙15-3∙89) and 2∙03 (1∙97-2∙09) times the odds respectively of dying in hospital with COVID-19 compared to those without diabetes, attenuated to 2∙86 and 1∙81 respectively when also adjusted for previous hospital admissions with coronary heart disease, cerebrovascular disease or heart failure.
Interpretation: This nationwide analysis in England demonstrates that all types of diabetes are independently associated with a significant increased risk of in-hospital death with COVID-19.
Funding: NHS England & Improvement and Public Health England.
Conflict of Interest: Jonathan Valabhji is the National Clinical Director for Diabetes and Obesity at NHS England & Improvement. Partha Kar is National Specialty Advisor for Diabetes and Obesity at NHS England & Improvement. Chirag Bakhai is the Primary Care Advisor to the NHS Diabetes Programme. Bob Young is Clinical lead for the National Diabetes Audit and a trustee of Diabetes UK. Kamlesh Khunti has acted as a consultant and speaker for Novartis, Novo Nordisk, Sanofi-Aventis, Lilly and Merck Sharp & Dohme. Kamlesh Khunti has also received grants in support of investigator and investigator-initiated trials from Novartis, Novo Nordisk, Sanofi-Aventis, Lilly, Merck Sharp & Dohme, Pfizer and Boehringer Ingelheim and has served on advisory boards for Novo Nordisk, Sanofi-Aventis, Lilly and Merck Sharp & Dohme. Naveed Sattar has consulted for Amgen, Astrazeneca, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, Pfizer and Sanofi and received grant support from Boehringer Ingelheim.
Keywords: COVID-19; SARS-CoV-2; coronavirus; SARS virus; diabetes; type 1 diabetes; type 2 diabetes; mortality; whole population study; cohort study; COVID-19 related mortality
Suggested Citation: Suggested Citation