COVID-19 Infection and Diabetes Incidence in Native Americans

项目摘要 美国印第安人和阿拉斯加原住民（美洲原住民）在新冠肺炎期间遭受了不成比例的痛苦- 与非疫情国家相比，2019冠状病毒病的感染率、住院率和死亡率更高 西班牙白人美洲原住民也不成比例地患有糖尿病， 患病率和2.3倍的非西班牙裔白人糖尿病相关的死亡率。越来越多的证据表明 COVID-19感染会增加患糖尿病的风险。大型队列研究报告称， 与匹配或历史对照相比，COVID-19感染后发生糖尿病的风险增加 没有已知的COVID-19感染虽然这些研究提供了重要的洞察力，新的风险的大小， 在COVID-19感染后发生的糖尿病中，现有的研究不包括一些最高风险的 人口，因为他们研究了美国退伍军人，商业保险患者参加了美国大型医疗保健机构， 保险计划和美国以外的社区。很少有人知道这种风险在不同的 美国境内的人口。了解2019冠状病毒病感染和糖尿病之间的流行病学联系， 美洲原住民对于解决面临不成比例的人口负担的健康差距至关重要。 COVID-19和糖尿病为了衡量COVID-19感染与糖尿病风险之间的关联， 我们将使用两个不同的数据源进行一系列分析：1）一个大型的，全国性的 通过印度卫生服务局提供的代表性临床数据库和2）阿拉斯加糖尿病登记处 阿拉斯加部落健康系统的电子健康记录数据。目标1将测量 通过一项匹配的研究， 回顾性队列研究，使用印度卫生服务局的国家数据。目的2将比较临床 在糖尿病发作时介绍糖尿病发病病例，并比较6个月内的临床进展 在回顾性队列个体中根据既往COVID-19感染状态进行诊断后， 来自印度卫生服务局和阿拉斯加糖尿病综合登记处的全国性数据 阿拉斯加土著部落健康联盟拟议的研究将提供一个全面的 美国原住民中COVID-19-糖尿病关联的流行病学评估，包括一项全国性的 描述COVID-19感染相关的糖尿病风险，并深入研究事件的临床表现 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 实体，以减轻COVID-19大流行对美洲原住民的影响，并进一步努力解决 这一人群面临的COVID-19和糖尿病健康差异。

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.