Frontiers in Public Health (Mar 2023)

The effect of diabetes on COVID-19 incidence and mortality: Differences between highly-developed-country and high-migratory-pressure-country populations

  • Marta Ottone,
  • Letizia Bartolini,
  • Laura Bonvicini,
  • Paolo Giorgi Rossi,
  • Reggio Emilia COVID-19 working group,
  • Massimo Costantini,
  • Roberto Grilli,
  • Massimiliano Marino,
  • Giulio Formoso,
  • Debora Formisano,
  • Ivano Venturi,
  • Cinzia Campari,
  • Francesco Gioia,
  • Serena Broccoli,
  • Marta Ottone,
  • Pierpaolo Pattacini,
  • Giulia Besutti,
  • Valentina Iotti,
  • Lucia Spaggiari,
  • Chiara Seidenari,
  • Licia Veronesi,
  • Paola Affanni,
  • Maria Eugenia Colucci,
  • Andrea Nitrosi,
  • Marco Foracchia,
  • Rossana Colla,
  • Marco Massari,
  • Anna Maria Ferrari,
  • Mirco Pinotti,
  • Nicola Facciolongo,
  • Ivana Lattuada,
  • Laura Trabucco,
  • Stefano De Pietri,
  • Giorgio Francesco Danelli,
  • Laura Albertazzi,
  • Enrica Bellesia,
  • Simone Canovi,
  • Mattia Corradini,
  • Tommaso Fasano,
  • Elena Magnani,
  • Annalisa Pilia,
  • Alessandra Polese,
  • Silvia Storchi Incerti,
  • Piera Zaldini,
  • Efrem Bonelli,
  • Bonanno Orsola,
  • Matteo Revelli,
  • Carlo Salvarani,
  • Carmine Pinto,
  • Pamela Mancuso,
  • Francesco Venturelli,
  • Massimo Vicentini,
  • Cinzia Perilli,
  • Elisabetta Larosa,
  • Eufemia Bisaccia,
  • Emanuela Bedeschi,
  • Alessandro Zerbini,
  • Paolo Giorgi Rossi

DOI
https://doi.org/10.3389/fpubh.2023.969143
Journal volume & issue
Vol. 11

Abstract

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The objective of this study was to compare the effect of diabetes and pathologies potentially related to diabetes on the risk of infection and death from COVID-19 among people from Highly-Developed-Country (HDC), including Italians, and immigrants from the High-Migratory-Pressure-Countries (HMPC). Among the population with diabetes, whose prevalence is known to be higher among immigrants, we compared the effect of body mass index among HDC and HMPC populations. A population-based cohort study was conducted, using population registries and routinely collected surveillance data. The population was stratified into HDC and HMPC, according to the place of birth; moreover, a focus was set on the South Asiatic population. Analyses restricted to the population with type-2 diabetes were performed. We reported incidence (IRR) and mortality rate ratios (MRR) and hazard ratios (HR) with 95% confidence interval (CI) to estimate the effect of diabetes on SARS-CoV-2 infection and COVID-19 mortality. Overall, IRR of infection and MRR from COVID-19 comparing HMPC with HDC group were 0.84 (95% CI 0.82–0.87) and 0.67 (95% CI 0.46–0.99), respectively. The effect of diabetes on the risk of infection and death from COVID-19 was slightly higher in the HMPC population than in the HDC population (HRs for infection: 1.37 95% CI 1.22–1.53 vs. 1.20 95% CI 1.14–1.25; HRs for mortality: 3.96 95% CI 1.82–8.60 vs. 1.71 95% CI 1.50–1.95, respectively). No substantial difference in the strength of the association was observed between obesity or other comorbidities and SARS-CoV-2 infection. Similarly for COVID-19 mortality, HRs for obesity (HRs: 18.92 95% CI 4.48–79.87 vs. 3.91 95% CI 2.69–5.69) were larger in HMPC than in the HDC population, but differences could be due to chance. Among the population with diabetes, the HMPC group showed similar incidence (IRR: 0.99 95% CI: 0.88–1.12) and mortality (MRR: 0.89 95% CI: 0.49–1.61) to that of HDC individuals. The effect of obesity on incidence was similar in both HDC and HMPC populations (HRs: 1.73 95% CI 1.41–2.11 among HDC vs. 1.41 95% CI 0.63–3.17 among HMPC), although the estimates were very imprecise. Despite a higher prevalence of diabetes and a stronger effect of diabetes on COVID-19 mortality in HMPC than in the HDC population, our cohort did not show an overall excess risk of COVID-19 mortality in immigrants.

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