Risk factor associations for severe COVID-19, influenza and pneumonia in people with diabetes to inform future pandemic preparations: UK population-based cohort study
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.P...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2024-01-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/1/e078135.full |
| _version_ | 1826805360064724992 |
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| author | Beverley M Shields Bilal A Mateen Andrew P McGovern John M Dennis Sebastian J Vollmer Daniyal Raja Rhian Hopkins Katherine G Young Nicholas J Thomas James Godwin Robert J Challen |
| author_facet | Beverley M Shields Bilal A Mateen Andrew P McGovern John M Dennis Sebastian J Vollmer Daniyal Raja Rhian Hopkins Katherine G Young Nicholas J Thomas James Godwin Robert J Challen |
| author_sort | Beverley M Shields |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-07T19:39:39Z |
| format | Article |
| id | doaj.art-d449e1a95edf4edf9c07de8a333b2eb9 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2025-03-17T02:09:12Z |
| publishDate | 2024-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-d449e1a95edf4edf9c07de8a333b2eb92025-02-13T07:20:15ZengBMJ Publishing GroupBMJ Open2044-60552024-01-0114110.1136/bmjopen-2023-078135Risk factor associations for severe COVID-19, influenza and pneumonia in people with diabetes to inform future pandemic preparations: UK population-based cohort studyBeverley M Shields0Bilal A Mateen1Andrew P McGovern2John M Dennis3Sebastian J Vollmer4Daniyal Raja5Rhian Hopkins6Katherine G Young7Nicholas J Thomas8James Godwin9Robert J Challen10Institute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, UKThe Alan Turing Institute, London, UKInstitute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, UKInstitute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, UKDepartment of Statistics, University of Warwick, Coventry, UKInstitute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, UKInstitute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, UKInstitute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, UKInstitute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, UKInstitute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, UKEngineering Mathematics, University of Bristol, Bristol, UKObjective 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.https://bmjopen.bmj.com/content/14/1/e078135.full |
| spellingShingle | Beverley M Shields Bilal A Mateen Andrew P McGovern John M Dennis Sebastian J Vollmer Daniyal Raja Rhian Hopkins Katherine G Young Nicholas J Thomas James Godwin Robert J Challen 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 |
| title | Risk factor associations for severe COVID-19, influenza and pneumonia in people with diabetes to inform future pandemic preparations: UK population-based cohort study |
| title_full | Risk factor associations for severe COVID-19, influenza and pneumonia in people with diabetes to inform future pandemic preparations: UK population-based cohort study |
| title_fullStr | Risk factor associations for severe COVID-19, influenza and pneumonia in people with diabetes to inform future pandemic preparations: UK population-based cohort study |
| title_full_unstemmed | Risk factor associations for severe COVID-19, influenza and pneumonia in people with diabetes to inform future pandemic preparations: UK population-based cohort study |
| title_short | Risk factor associations for severe COVID-19, influenza and pneumonia in people with diabetes to inform future pandemic preparations: UK population-based cohort study |
| title_sort | risk factor associations for severe covid 19 influenza and pneumonia in people with diabetes to inform future pandemic preparations uk population based cohort study |
| url | https://bmjopen.bmj.com/content/14/1/e078135.full |
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