Risks of and risk factors for COVID-19 disease in people with diabetes: a cohort study of the total population of Scotland.
Risks of and risk factors for COVID-19 disease in people with diabetes: a cohort study of the total population of Scotland.
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糖尿病患者COVID-19疾病的风险和风险因素：苏格兰总人口的队列研究。
DOI：
10.1016/s2213-8587(20)30405-8
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发表时间：
2021-03
期刊：
影响因子：
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通讯作者：
Scottish Diabetes Research Network Epidemiology Group
中科院分区：
文献类型：
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作者：
McGurnaghan SJ;Weir A;Bishop J;Kennedy S;Blackbourn LAK;McAllister DA;Hutchinson S;Caparrotta TM;Mellor J;Jeyam A;O'Reilly JE;Wild SH;Hatam S;Höhn A;Colombo M;Robertson C;Lone N;Murray J;Butterly E;Petrie J;Kennon B;McCrimmon R;Lindsay R;Pearson E;Sattar N;McKnight J;Philip S;Collier A;McMenamin J;Smith-Palmer A;Goldberg D;McKeigue PM;Colhoun HM;Public Health Scotland COVID-19 Health Protection Study Group;Scottish Diabetes Research Network Epidemiology Group
我们的目的是确定糖尿病患者中致命或重症监护病房治疗的 COVID-19 的累积风险，并将其与非糖尿病患者进行比较，调查糖尿病患者中致命或重症监护病房治疗的 COVID-19 的风险因素并建立交叉验证的预测模型。在这项队列研究中，我们捕获了苏格兰第一波疫情的数据，从 2020 年 3 月 1 日发现第一例病例到 2020 年 7 月 31 日感染率大幅下降以至于屏蔽措施正式终止。参与者是苏格兰的总人口，包括在苏格兰大流行开始前 3 周（估计为 2020 年 2 月 7 日）还活着的所有糖尿病患者。我们通过苏格兰电子监测通信数据库（病毒学）、每日住院的 RAPID 数据库、出院的苏格兰发病记录-01、苏格兰国家记录死亡登记数据以及苏格兰重症监护协会和审计小组数据库（重症监护），确定了在此期间有多少人出现致命或接受重症监护病房治疗的 COVID-19。在接受致命或重症监护病房治疗的 COVID-19 患者中，糖尿病状况是通过与国家糖尿病登记册、苏格兰护理信息糖尿病联系起来确定的。我们使用逻辑回归比较了患有和不患有糖尿病的人中致命或重症监护病房治疗的 COVID-19 的累积发生率。对于糖尿病患者，我们从国家糖尿病登记册和其他链接的健康管理数据库中获取了有关致命或重症监护病房治疗的 COVID-19 潜在风险因素的数据。我们测试了这些因素与糖尿病患者中致命或重症监护室治疗的 COVID-19 的关联，并使用逐步回归和 20 倍交叉验证构建了一个预测模型。截至 2020 年 3 月 1 日，苏格兰总人口 (n=5 463 300) 中，糖尿病人口为 319 349 (5·8%)，其中 1082 (0·3%) 截至 2020 年 7 月 31 日出现致命或接受重症监护病房治疗的 COVID-19，其中 972 人 (89·8%) 年龄在 60 岁或以上。在没有糖尿病的人群中，5 143 951 人中有 4081 人 (0·1%) 出现致命或接受重症监护病房治疗的 COVID-19。截至 7 月 31 日，与非糖尿病患者的风险相比，经年龄和性别调整后，糖尿病的总体比值比 (OR) 为 1·395 (95% CI 1·304–1·494；p<0·0001)。1 型糖尿病和 1 型糖尿病的 OR 为 2·396 (1·815–3·163；p<0·0001)。 2 型糖尿病患者为 1·369 (1·276–1·468；p<0·0001)。在糖尿病患者中，根据年龄、性别、糖尿病持续时间和类型进行调整后，那些出现致命或接受重症监护病房治疗的 COVID-19 的患者更有可能是男性、居住在住院护理或更贫困的地区、患有 COVID-19 风险状况、视网膜病变、减少 肾功能不佳，或血糖控制较差，过去 5 年内曾因糖尿病酮症酸中毒或低血糖住院，服用更多抗糖尿病药物和其他药物（均 p<0·0001），并且曾经吸烟（p=0·0011）。经交叉验证的糖尿病患者致命或重症监护病房治疗的 COVID-19 预测模型 C 统计量为 0·85 (0·83–0·86)。与背景人群相比，1 型和 2 型糖尿病患者发生致命或接受重症监护病房治疗的 COVID-19 的总体风险显着升高。糖尿病患者中致命或重症监护病房治疗的 COVID-19 的风险以及因此需要采取的特殊保护措施差异很大，但可以使用之前的数据进行合理预测 临床病史。没有。
We aimed to ascertain the cumulative risk of fatal or critical care unit-treated COVID-19 in people with diabetes and compare it with that of people without diabetes, and to investigate risk factors for and build a cross-validated predictive model of fatal or critical care unit-treated COVID-19 among people with diabetes. In this cohort study, we captured the data encompassing the first wave of the pandemic in Scotland, from March 1, 2020, when the first case was identified, to July 31, 2020, when infection rates had dropped sufficiently that shielding measures were officially terminated. The participants were the total population of Scotland, including all people with diabetes who were alive 3 weeks before the start of the pandemic in Scotland (estimated Feb 7, 2020). We ascertained how many people developed fatal or critical care unit-treated COVID-19 in this period from the Electronic Communication of Surveillance in Scotland database (on virology), the RAPID database of daily hospitalisations, the Scottish Morbidity Records-01 of hospital discharges, the National Records of Scotland death registrations data, and the Scottish Intensive Care Society and Audit Group database (on critical care). Among people with fatal or critical care unit-treated COVID-19, diabetes status was ascertained by linkage to the national diabetes register, Scottish Care Information Diabetes. We compared the cumulative incidence of fatal or critical care unit-treated COVID-19 in people with and without diabetes using logistic regression. For people with diabetes, we obtained data on potential risk factors for fatal or critical care unit-treated COVID-19 from the national diabetes register and other linked health administrative databases. We tested the association of these factors with fatal or critical care unit-treated COVID-19 in people with diabetes, and constructed a prediction model using stepwise regression and 20-fold cross-validation. Of the total Scottish population on March 1, 2020 (n=5 463 300), the population with diabetes was 319 349 (5·8%), 1082 (0·3%) of whom developed fatal or critical care unit-treated COVID-19 by July 31, 2020, of whom 972 (89·8%) were aged 60 years or older. In the population without diabetes, 4081 (0·1%) of 5 143 951 people developed fatal or critical care unit-treated COVID-19. As of July 31, the overall odds ratio (OR) for diabetes, adjusted for age and sex, was 1·395 (95% CI 1·304–1·494; p<0·0001, compared with the risk in those without diabetes. The OR was 2·396 (1·815–3·163; p<0·0001) in type 1 diabetes and 1·369 (1·276–1·468; p<0·0001) in type 2 diabetes. Among people with diabetes, adjusted for age, sex, and diabetes duration and type, those who developed fatal or critical care unit-treated COVID-19 were more likely to be male, live in residential care or a more deprived area, have a COVID-19 risk condition, retinopathy, reduced renal function, or worse glycaemic control, have had a diabetic ketoacidosis or hypoglycaemia hospitalisation in the past 5 years, be on more anti-diabetic and other medication (all p<0·0001), and have been a smoker (p=0·0011). The cross-validated predictive model of fatal or critical care unit-treated COVID-19 in people with diabetes had a C-statistic of 0·85 (0·83–0·86). Overall risks of fatal or critical care unit-treated COVID-19 were substantially elevated in those with type 1 and type 2 diabetes compared with the background population. The risk of fatal or critical care unit-treated COVID-19, and therefore the need for special protective measures, varies widely among those with diabetes but can be predicted reasonably well using previous clinical history. None.