Incremental risk of developing severe COVID-19 among Mexican patients with diabetes attributed to social and healthcare access disadvantages

Diabetes mellitus is an important risk factor for severe 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 healthcare, 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 SARS-CoV-2 between March 1st and July 31st, 2020. The primary outcome was the predicted probability of hospitalization, inclusive of 8.5% of patients who required intensive care unit (ICU) 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 state-level healthcare 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 healthcare 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.