The effect of age on the association between diabetes and mortality in adult patients with COVID-19 in Mexico

  1. Orison O. Woolcott
  2. Juan P. Castilla-Bancayán

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Abstract

Diabetes is associated with severe COVID-19 and mortality. The aim of the present study was to determine the effect of age on the association between diabetes and mortality in patients with laboratory-confirmed COVID-19 in Mexico. This retrospective cohort study involved patients aged 20 years or older with symptoms of viral respiratory disease who were screened for SARS-CoV-2 infection across the System of Epidemiological Surveillance of Viral Respiratory Disease in Mexico from January 1 through November 4, 2020. Cox proportional-hazard regression was used to calculate the hazard ratio for 28-day mortality and its 95% confidence interval (CI). Among 757,210 patients with COVID-19 (outpatients and inpatients), 120,476 (16%) had diabetes and 80,616 died. Among 878,840 patients without COVID-19 (those who tested negative for SARS-CoV-2 infection), 88,235 (10.0%) had diabetes and 20,134 died. Among patients with COVID-19, diabetes was associated with a hazard ratio for death of 1.49 (95% CI 1.47–1.52), adjusting for age, sex, smoking habit, obesity, hypertension, immunodeficiency, and cardiovascular, pulmonary, and chronic renal disease. The strength of the association decreased with age (trend test: P  = 0.004). For example, the adjusted hazard ratio for death was 3.12 (95% CI 2.86–3.40) for patients 20–39 years of age; in contrast, the adjusted hazard ratio of death for patients 80 years of age or older was 1.11 (95% CI 1.06–1.16). The adjusted hazard ratios were 1.66 (95% CI 1.58–1.74) in outpatients and 1.14 (95% CI 1.12–1.16) in inpatients. In hospitalized patients 80 years of age or older, no association was observed between diabetes and COVID-19-related mortality (adjusted hazard ratio: 1.03; 95% CI 0.98–1.08). Among patients without COVID-19, the adjusted hazard ratio for death was 1.78 (95% CI 1.73–1.84). In conclusion, in adult patients with COVID-19 in Mexico, the risk of death associated with diabetes decreased with age. No association between diabetes and mortality was observed among inpatients 80 years of age or older. Our findings should be verified in other populations.

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  1. Version published to 10.1038/s41598-021-88014-z
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    SciScore for 10.1101/2020.11.25.20238345: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementSince this study involved the analysis of publicly available de-identified data only, institutional-review-board review was not required, as outlined in the Federal Policy for the Protection of Human Subjects (detailed in 45 CFR part 46).Randomizationnot detected.Blindingnot detected.Power Analysisnot detected.Sex as a biological variableMale sex, n (%).

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    (StataCorp LP, TX).
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

    261 Limitations of this study include self-reported diabetes, unknown type of diabetes, and unknown 262 diabetes status. The proportion of patients with diabetes in the overall population (with and 263 without COVID-19) was 12.8%, slightly lower than the adult prevalence of diabetes in Mexico 264 (15.2%).34 Our regression models were not adjusted for ethnicity or clinical and laboratory 265 variables since data were not available. Proper blood glucose control has been associated with 266 lower COVID-19-related mortality.35 Another limitation of our study is that we cannot exclude the possibility that the number of deaths in patients who had COVID-19 could be underreported. 268 Finally, since our analysis was restricted to patients who presented symptoms for suspected viral 269 respiratory disease and only 10% of patients with mild symptoms of viral respiratory disease 270 were reported to the surveillance system, our findings may not be generalizable to populations 271 with asymptomatic or mild COVID-19. 272 273 274 275 276 277 278 279 280 281 282 283 284

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    About SciScore

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  3. Version published to 10.1101/2020.11.25.20238345v1 on medRxiv