Quantifying association and disparities between diabetes complications and COVID-19 outcomes: A retrospective study using electronic health records

• Published in: PloS one 2023-09, Vol.18 (9), p.e0286815-e0286815
• Main Authors: Paramita, Ni Luh Putu S. P, Agor, Joseph K, Mayorga, Maria E, Ivy, Julie S, Miller, Kristen E, Ozaltin, Osman Y
• Format: Article
• Language: English
• Subjects: African Americans; Biology and Life Sciences; Cardiovascular disease; Comorbidity; Complications; Complications and side effects; COVID-19; Demographics; Demography; Diabetes; Diabetes mellitus; Diabetes therapy; Diabetics; Diagnosis; Electronic health records; Electronic medical records; Electronic records; Ethnicity; Evaluation; Health care disparities; Health risks; Hospitalization; Hospitals; Hyperglycemia; Hypertension; Infection; Infections; Kidney diseases; Length of stay; Mathematical analysis; Medical records; Medicine and Health Sciences; Metabolism; Metabolites; Mortality; Pandemics; Patients; People and Places; Risk factors; Severe acute respiratory syndrome coronavirus 2; Stroke; Type 2 diabetes; United States
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0286815

Background Despite established relationships between diabetic status and an increased risk for COVID-19 severe outcomes, there is a limited number of studies examining the relationships between diabetes complications and COVID-19-related risks. We use the Adapted Diabetes Complications Severity Index to define seven diabetes complications. We aim to understand the risk for COVID-19 infection, hospitalization, mortality, and longer length of stay of diabetes patients with complications. Methods We perform a retrospective case-control study using Electronic Health Records (EHRs) to measure differences in the risks for COVID-19 severe outcomes amongst those with diabetes complications. Using multiple logistic regression, we calculate adjusted odds ratios (OR) for COVID-19 infection, hospitalization, and in-hospital mortality of the case group (patients with diabetes complications) compared to a control group (patients without diabetes). We also calculate adjusted mean difference in length of stay between the case and control groups using multiple linear regression. Results Adjusting demographics and comorbidities, diabetes patients with renal complications have the highest odds for COVID-19 infection (OR = 1.85, 95% CI = [1.71, 1.99]) while those with metabolic complications have the highest odds for COVID-19 hospitalization (OR = 5.58, 95% CI = [3.54, 8.77]) and in-hospital mortality (OR = 2.41, 95% CI = [1.35, 4.31]). The adjusted mean difference (MD) of hospital length-of-stay for diabetes patients, especially those with cardiovascular (MD = 0.94, 95% CI = [0.17, 1.71]) or peripheral vascular (MD = 1.72, 95% CI = [0.84, 2.60]) complications, is significantly higher than non-diabetes patients. African American patients have higher odds for COVID-19 infection (OR = 1.79, 95% CI = [1.66, 1.92]) and hospitalization (OR = 1.62, 95% CI = [1.39, 1.90]) than White patients in the general diabetes population. However, White diabetes patients have higher odds for COVID-19 in-hospital mortality. Hispanic patients have higher odds for COVID-19 infection (OR = 2.86, 95% CI = [2.42, 3.38]) and shorter mean length of hospital stay than non-Hispanic patients in the general diabetes population. Although there is no significant difference in the odds for COVID-19 hospitalization and in-hospital mortality between Hispanic and non-Hispanic patients in the general diabetes population, Hispanic patients have higher odds for COVID-19 hospitalization (OR = 1.83, 95% CI = [1.16, 2