COVID-19 Infection and Diabetes Incidence in Native Americans

项目摘要 美洲印第安人和阿拉斯加原住民(美国原住民)在COVID期间遭受了不成比例的痛苦- 19与非新冠肺炎疫情相比，新冠肺炎的感染率、住院率和死亡率更高 西班牙裔白人。美洲原住民也患有不成比例的糖尿病，几乎是 与糖尿病相关的死亡率是非西班牙裔白人的2.3倍。越来越多的证据表明 新冠肺炎感染会增加患糖尿病的风险。大型队列研究报告了~50% 与匹配或既往对照相比，新冠肺炎感染后患糖尿病的风险增加 没有已知的新冠肺炎感染。虽然这些研究提供了对新的风险程度的重要洞察 新冠肺炎感染后发生糖尿病，现有研究不包括一些最高风险 人口，因为他们研究了美国退伍军人，商业保险患者参加了大型美国健康 保险计划和美国以外的社区。这种风险在不同的地区是如何变化的，我们知之甚少 美国境内的人口。了解新冠肺炎感染与糖尿病之间的流行病学联系 美洲原住民对于解决健康差距至关重要，因为他们面临着不成比例的 新冠肺炎和糖尿病都有。为了衡量新冠肺炎感染与糖尿病风险之间的关系， 我们将使用两个不同的数据来源进行一系列分析：1)全国范围内的大型 有代表性的临床数据库可通过印度健康服务和2)阿拉斯加糖尿病登记处获得 与来自阿拉斯加部落健康系统的电子健康记录数据相关联。目标1将测量 在美洲土著人中，新冠肺炎感染与糖尿病发病风险之间的关系， 使用印度卫生服务机构的国家数据进行的回溯性队列研究。目标2将比较临床上 糖尿病患者发病时的发病情况，并比较6个月内的临床进展 根据先前新冠肺炎感染状况进行诊断后，对使用 来自印度健康服务和阿拉斯加糖尿病综合登记处的全国数据得到维护 阿拉斯加原住民部落健康联盟。拟议的研究将提供一个全面的 新冠肺炎-糖尿病协会在美洲土著人中的流行病学评估，包括全国范围的 新冠肺炎感染相关糖尿病风险的描述和事件的临床表现 糖尿病病例。这些知识将支持部落、联邦、州和社区的持续努力 减轻新冠肺炎大流行对美洲土著人影响的实体和进一步努力解决 这一人群面临的新冠肺炎和糖尿病健康差距。

PROJECT ABSTRACT American Indians and Alaska Natives (Native Americans) have suffered disproportionately during the COVID- 19 pandemic with higher rates of infection, hospitalization and mortality from COVID-19 compared to Non- Hispanic Whites. Native Americans also suffer disproportionately from diabetes with nearly 3 times the prevalence and 2.3 times the diabetes-related death rate of Non-Hispanic Whites. Growing evidence suggests that COVID-19 infection increases the risk of developing diabetes. Large cohort studies have reported a ~50% increased risk of developing diabetes following COVID-19 infection compared to matched or historic controls without known COVID-19 infection. While these studies offer important insight into the magnitude of risk of new onset diabetes following COVID-19 infection, existing studies were not inclusive of some of the highest risk populations because they studied US veterans, commercially insured patients enrolled in large US health insurance plans, and communities outside the US. Little is known how this risk varies across diverse populations within the US. Understanding the epidemiologic links between COVID-19 infection and diabetes in Native Americans is critical to address health disparities in a population that faces a disproportionate burden of both COVID-19 and diabetes. To measure the association between COVID-19 infection and diabetes risk in Native Americans we will conduct a series of analyses using two distinct data sources: 1) a large, nationally representative clinical database available through Indian Health Service and 2) the Alaska Diabetes Registry with linked electronic health record data from the Alaska Tribal Health System. Aim 1 will measure the association between COVID-19 infection and risk of incident diabetes in Native Americans via a matched, retrospective cohort study using national data from the Indian Health Service. Aim 2 will compare the clinical presentation of incident diabetes cases at diabetes onset and compare clinical progression over the 6 months following diagnosis by antecedent COVID-19 infection status in a retrospective cohort of individuals using nationwide data from Indian Health Service as well as the comprehensive Alaska Diabetes Registry maintained by the Alaska Native Tribal Health Consortium. The proposed studies will provide a comprehensive epidemiologic assessment of the COVID-19-diabetes association in Native Americans, including a nationwide description of COVID-19 infection-related diabetes risk and a deep dive into the clinical presentation of incident diabetes cases. This knowledge will support the continued efforts of Tribal, Federal, State, and community entities to mitigate the impacts of the COVID-19 pandemic in Native Americans and further efforts to address the COVID-19 and diabetes health disparities faced by this population.