Social vulnerability drives COVID-19 hospitalization risk in Mexican adults with diabetes
Mexican adults with diabetes living in areas of high social deprivation and low health care resources are significantly more likely to be hospitalized for COVID-19 complications compared with adults living in higher-resource settings.
In a database analysis of more than 370,000 adults diagnosed with COVID-19 in Mexico, researchers also found that speaking an indigenous language was associated with an incremental probability of severe COVID-19 among individuals with diabetes and one or more comorbidities, such as obesity or hypertension.
“Before the COVID-19 outbreak, type 2 diabetes, which is highly prevalent among individuals of low socioeconomic status in Mexico, represented one of the most significant challenges to Mexican health care, a fragmented health system, in a major process of transition, with well-documented disparities in health care delivery,” Sandra G. Sosa-Rubi, PhD, MS, a research associates with the Center for Health Systems Research at the National Institute for Public Health in Morelos, Mexico, and colleagues wrote in Diabetes Care. “The convergence of the COVID-19 and diabetes epidemics has widened these preexisting health disparities in Mexico, thus raising the urgent need to better understand factors associated with poor outcomes among individuals with diabetes and COVID-19.”
In an observational, cross-sectional study, Sosa-Rubi and colleagues analyzed data from 373,963 adults with laboratory-confirmed COVID-19 diagnosed from March 1 to July 31, using public data from the General Directorate of Epidemiology of the Mexican Ministry of Health. Primary outcome was the predicted probability of hospitalization, inclusive of 8.5% of patients who required ICU admission.
Within the cohort, 73.8% of patients required ambulatory care and 26.2% required hospitalization. Diabetes was self-reported among 10.5% of patients who presented for ambulatory care and among 32.2% of hospitalized patients. Compared with those who presented to ambulatory care, hospitalized patients were more likely to speak an indigenous language (1.4% vs. 0.9%), live in the highest municipality social deprivation level (21% vs. 19.6%) or have a comorbidity.
The predicted probability of COVID-19-related hospitalization was 38.4% (95% CI, 37.6-39.2) for patients with diabetes only and 42.9% (95% CI, 42.2-43.7) for patients with diabetes and one or more comorbidities, such as obesity, hypertension, cardiovascular disease and chronic kidney disease.
Researchers found that a high municipality-level of social deprivation and low state-level health care resources were associated with a 9.5% (95% CI, 6.3-12.7) and 17.5% (95% CI, 14.5-20.4) increased probability for hospitalization among patients with diabetes, respectively. In age-, sex-, and comorbidity-adjusted models, living in a context of high social vulnerability and low health care resources was associated with the highest predicted probability of hospitalization.
Additionally, patients with diabetes and COVID-19 who spoke an indigenous language were more likely to be hospitalized for complications vs. those who did not speak an indigenous language (35.4% vs. 11.7%).
“These findings confirm what has been previously documented on the role of diabetes and associated comorbidities on severe COVID-19 and add to the existing literature on social disparities uncovered by this epidemic by highlighting social vulnerability characteristics that amplify the risk of severe COVID-19 in this high-risk population,” the researchers wrote.
The researchers noted the findings can guide resource allocation aimed at reducing gaps in access to health care and implement measures to mitigate risk for COVID-19 among socially vulnerable populations with the highest risk for severe complications.