Risk Factors Associated with COVID-19 Hospitalization and Mortality: A Large Claims-Based Analysis Among People with Type 2 Diabetes Mellitus in the United States
Boye et al.
, Risk Factors Associated with COVID-19 Hospitalization and Mortality: A Large Claims-Based Analysis Among..
, Diabetes Therapy, doi:10.1007/s13300-021-01110-1
Retrospective 9531 COVID+ diabetes patients in the USA, showing lower risk of hospitalization with existing biguanides treatment (defined as mainly metformin in the abstract and entirely metformin in the text).
risk of hospitalization, 10.0% lower, RR 0.90, p < 0.001, treatment 2,067 of 4,250 (48.6%), control 3,196 of 5,281 (60.5%), NNT 8.4, odds ratio converted to relative risk.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Boye et al., 18 Jul 2021, retrospective, USA, peer-reviewed, 14 authors.
Abstract: Diabetes Ther (2021) 12:2223–2239
Risk Factors Associated with COVID-19
Hospitalization and Mortality: A Large Claims-Based
Analysis Among People with Type 2 Diabetes Mellitus
in the United States
Kristina S. Boye . Elif Tokar Erdemir . Nathan Zimmerman . Abraham Reddy . Brian D. Benneyworth .
Matan C. Dabora . Emily R. Hankosky . M. Angelyn Bethel . Callahan Clark . Cody J. Lensing . Scott Sailer .
Ramira San Juan . Robert J. Heine . Lida Etemad
Received: April 28, 2021 / Accepted: June 28, 2021 / Published online: July 18, 2021
Ó The Author(s) 2021
Introduction: Diabetes has been identified as a
high-risk comorbidity for COVID-19 hospitalization. We evaluated additional risk factors for
COVID-19 hospitalization and in-hospital
mortality in a nationwide US database.
Methods: This retrospective study utilized the
UnitedHealth Group Clinical Discovery Database (January 1, 2019–July 15, 2020) containing
de-identified nationwide administrative claims,
SARS-CoV-2 laboratory test results, and COVID19 inpatient admissions data. Logistic regression was used to understand risk factors for
hospitalization and in-hospital mortality
among people with type 2 diabetes (T2D) and in
the overall population. Robustness of associations was further confirmed by subgroup and
sensitivity analyses in the T2D population.
Supplementary Information The online version
contains supplementary material available at https://
K. S. Boye B. D. Benneyworth M. C. Dabora
E. R. Hankosky M. A. Bethel R. J. Heine
Eli Lilly and Company, Indianapolis, IN, USA
E. Tokar Erdemir (&) N. Zimmerman A. Reddy
C. Clark C. J. Lensing S. Sailer R. San Juan
OptumLabs at UnitedHealth Group, Minneapolis,
Results: A total of 36,364 people were identified who were either SARS-CoV-2? or hospitalized for COVID-19. T2D was associated with
increased COVID-19-related hospitalization and
mortality. Factors associated with increased
hospitalization risk were largely consistent in
the overall population and the T2D subgroup,
including age, male sex, and these top five
comorbidities: dementia, metastatic tumor,
congestive heart failure, paraplegia, and metabolic disease. Biguanides (mainly metformin)
were consistently associated with lower odds of
hospitalization, whereas sulfonylureas and
insulins were associated with greater odds of
hospitalization among people with T2D.
Conclusion: In this nationwide US analysis,
T2D was identified as an independent risk factor
for COVID-19 complications. Many factors
conferred similar risk of hospitalization across
both populations; however, particular diabetes
medications may be markers for differential
risk. The insights on comorbidities and medications may inform population health initiatives, including prevention efforts for high-risk
patient populations such as those with T2D.
Keywords: Claim-based analysis; COVID-19;
Risk factors; SARS-CoV-2; Type 2 diabetes
Key Summary Points
Why carry out this study?
The clinical and demographic
characteristics as well as specific risk
factors of patients with diabetes with
severe forms of COVID-19 in the US have
not been extensively studied.
This study aimed to characterize
additional risk factors for COVID-19
hospitalization and in-hospital mortality
among those with type 2 diabetes mellitus
(T2DM) and the overall population in..
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