Incremental Risk of Developing Severe COVID-19 Among Mexican Patients With Diabetes Attributed to Social and Health Care Access Disadvantages

Abstract

Diabetes is an important risk factor for severe coronavirus disease 2019 (COVID-19), but little is known about the marginal effect of additional risk factors for severe COVID-19 among individuals with diabetes. We tested the hypothesis that sociodemographic, access to health care, and presentation to care characteristics among individuals with diabetes in Mexico confer an additional risk of hospitalization with COVID-19. RESEARCH DESIGN AND METHODS We conducted a cross-sectional study using public data from the General Directorate of Epidemiology of the Mexican Ministry of Health. We included individuals with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 between 1 March and 31 July 2020. The primary outcome was the predicted probability of hospitalization, inclusive of 8.5% of patients who required intensive care unit admission. RESULTS Among 373,963 adults with COVID-19, 16.1% (95% CI 16.0-16.3) self-reported diabetes. The predicted probability of hospitalization was 38.4% (37.6-39.2) for patients with diabetes only and 42.9% (42.2-43.7) for patients with diabetes and one or more comorbidities (obesity, hypertension, cardiovascular disease, and chronic kidney disease). High municipality-level of social deprivation and low statelevel health care resources were associated with a 9.5% (6.3-12.7) and 17.5% (14.5-20.4) increased probability of hospitalization among patients with diabetes, respectively. In age-, sex-, and comorbidity-adjusted models, living in a context of high social vulnerability and low health care resources was associated with the highest predicted probability of hospitalization. CONCLUSIONS Social vulnerability contributes considerably to the probability of hospitalization among individuals with COVID-19 and diabetes with associated comorbidities. These findings can inform mitigation strategies for populations at the highest risk of severe COVID-19.

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“…This becomes highly relevant because uncontrolled blood glucose levels increase the chances of a viral infection, since DM is one of the main comorbidities [ 178 ] in the infection, development and worsening of COVID-19 [ 179 ]. Recent reports in China [ 180 ], Italy, and Mexico [ 181 , 182 , 183 ] have revealed that older patients with chronic diseases, especially DM, display a higher probability for contracting a severe condition in COVID-19 disease and that frequently, this leads to fatal consequences. Some of the mechanisms probably involved in the susceptibility to COVID-19 by patients with DM include: high affinity for binding the virus to the cell and efficient entry, decreased function of T cells, increased of susceptibility to hyperinflammation and cytokine storm syndrome, and the presence of cardiovascular diseases [ 184 ].…”

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“…The comorbidities that most increased the risk of intensive care unit stay and intubation were diabetes, immunosuppression, and obesity[14]. In this study, 1803 participants (almost 43.89%) had at 4% (37.6-39.2) for patients with diabetes only and 42.9% (42.2-43.7) for those with diabetes and one or more comorbidities[17].Regarding arterial hypertension in Mexico, according to the National Health and Nutrition Survey of Medio Camino 2016, carried out by the National Institute of Public Health (INSP) and the Ministry of Health, one in four adults in Mexico had arterial hypertension.…”

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“…This risk factor should also be analyzed in depth by the Mexican health authorities since previous studies support that this is a signi cant public health problem in this population and that it is a trigger for severe COVID-19, especially in people with social disadvantages and limited access to medical care [24].…”