Institute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, UK
Institute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, UK.
BMJ Open. 2024 Jan 31;14(1):e078135. doi: 10.1136/bmjopen-2023-078135.
This study aimed to compare clinical and sociodemographic risk factors for severe COVID-19, influenza and pneumonia, in people with diabetes.
Population-based cohort study.
UK primary care records (Clinical Practice Research Datalink) linked to mortality and hospital records.
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).
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.
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.
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.
本研究旨在比较糖尿病患者中 COVID-19、流感和肺炎的临床和社会人口学危险因素。
基于人群的队列研究。
英国初级保健记录（临床实践研究数据链接）与死亡率和住院记录相关联。
1 型和 2 型糖尿病患者（COVID-19 队列：n=43033 型 1 糖尿病和 n=584854 型 2 糖尿病，流感和肺炎队列：n=42488 型 1 糖尿病和 n=585289 型 2 糖尿病）。
2020 年 2 月 1 日至 2020 年 10 月 31 日（COVID-19 疫苗推出前）COVID-19 住院治疗，2016 年 9 月 1 日至 2019 年 5 月 31 日（COVID-19 大流行前）流感和肺炎住院治疗。次要结局是 COVID-19 和肺炎死亡率。使用多变量 Cox 比例风险模型评估临床和社会人口学危险因素与每种结局的相关性。在 2 型糖尿病患者中，我们探讨了糖化血红蛋白（HbA1c）和体重指数（BMI）随年龄、性别和种族的修饰作用。
在 2 型糖尿病中，血糖控制不佳和严重肥胖与 COVID-19、流感和肺炎住院风险增加一致相关。在年龄低于 70 岁的人群中观察到 HbA1c 和 BMI 相关的相对风险最高。社会人口学相关的风险因呼吸道感染而有显著差异，特别是种族。与白种人相比，黑人和南亚群体 COVID-19 住院的风险更高，但肺炎住院的风险更低。1 型糖尿病和 2 型糖尿病死亡率的危险因素关联与主要分析基本一致。
高 HbA1c 和严重肥胖等临床危险因素与 COVID-19、流感和肺炎的严重结局密切相关，尤其是在年轻人中。相比之下，与社会人口学危险因素的关联因呼吸道感染类型而异。这强调了风险分层应针对特定的呼吸道感染。
