Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study
Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study
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DOI：
10.1016/s2213-8587(20)30271-0
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发表时间：
2020-10-01
影响因子：
44.5
通讯作者：
Valabhji, Jonathan
中科院分区：
文献类型：
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作者：
Holman, Naomi;Knighton, Peter;Valabhji, Jonathan
糖尿病与COVID-19相关死亡率增加有关，但糖尿病患者中可改变的风险因素（包括高血糖和肥胖）与COVID-19相关死亡率之间的关联尚不清楚。我们评估了1型和2型糖尿病患者中风险因素与COVID-19相关死亡率之间的关联。方法我们对在英格兰全科诊所注册的确诊糖尿病患者进行了一项基于人群的队列研究。由国家糖尿病审计整理的1型和2型糖尿病患者的全国人口数据与国家统计局从2017年1月2日至2020年5月11日整理的死亡率记录相关联。我们确定了2020年前19周内1型和2型糖尿病患者的每周死亡人数，并计算了2017年，2018年和2019年相应周的平均死亡人数的百分比变化。风险因素之间的关联（包括性别、年龄、种族、社会经济贫困、HbA 1c、肾损害[根据估计的肾小球滤过率（eGFR）]、BMI、吸烟状况和心血管合并症）和COVID-19相关死亡率（定义为国际疾病分类，第10版，代码U07.1或U07.2作为主要或次要死亡原因），结果2020年前19周的每周死亡登记超过2017-19年相应的3年每周平均值，其中1型糖尿病患者672人（50. 9%），2型糖尿病患者16 071人（64. 3%）。2020年2月16日至5月11日，在264390名1型糖尿病患者和2874020名2型糖尿病患者中，1604名1型糖尿病患者和36291名2型糖尿病患者死于各种原因。在这些死亡总数中，464例1型糖尿病患者和10525例2型糖尿病患者被定义为COVID-19相关，其中分别有289例（62.3%）和5833例（55.4%）发生在有心血管疾病史或肾功能损害（eGFR）的人群中
Background Diabetes has been associated with increased COVID-19-related mortality, but the association between modifiable risk factors, including hyperglycaemia and obesity, and COVID-19-related mortality among people with diabetes is unclear. We assessed associations between risk factors and COVID-19-related mortality in people with type 1 and type 2 diabetes.Methods We did a population-based cohort study of people with diagnosed diabetes who were registered with a general practice in England. National population data on people with type 1 and type 2 diabetes collated by the National Diabetes Audit were linked to mortality records collated by the Office for National Statistics from Jan 2, 2017, to May 11, 2020. We identified the weekly number of deaths in people with type 1 and type 2 diabetes during the first 19 weeks of 2020 and calculated the percentage change from the mean number of deaths for the corresponding weeks in 2017, 2018, and 2019. The associations between risk factors (including sex, age, ethnicity, socioeconomic deprivation, HbA1c, renal impairment [from estimated glomerular filtration rate (eGFR)], BMI, tobacco smoking status, and cardiovascular comorbidities) and COVID-19-related mortality (defined as International Classification of Diseases, version 10, code U07.1 or U07.2 as a primary or secondary cause of death) between Feb 16 and May 11, 2020, were investigated by use of Cox proportional hazards models.Findings Weekly death registrations in the first 19 weeks of 2020 exceeded the corresponding 3-year weekly averages for 2017-19 by 672 (50.9%) in people with type 1 diabetes and 16 071 (64.3%) in people with type 2 diabetes. Between Feb 16 and May 11, 2020, among 264 390 people with type 1 diabetes and 2 874 020 people with type 2 diabetes, 1604 people with type 1 diabetes and 36 291 people with type 2 diabetes died from all causes. Of these total deaths, 464 in people with type 1 diabetes and 10 525 in people with type 2 diabetes were defined as COVID-19 related, of which 289 (62.3%) and 5833 (55.4%), respectively, occurred in people with a history of cardiovascular disease or with renal impairment (eGFR