Type 2 diabetes ‘disproportionately’ affects COVID-19 mortality risk in middle-aged adults
Middle-aged adults with type 2 diabetes have a disproportionate risk increase for COVID-19 mortality and should receive priority for early vaccination, according to a research letter published in Diabetologia.
“We triangulated information from several big studies that all show a very similar disproportionate risk in middle-aged people,” John M. Dennis, PhD, an independent research fellow at the University of Exeter Medical School in the United Kingdom, told Healio. “This is clear evidence that middle-aged people with diabetes should be prioritized for vaccination. Although the U.K. vaccination priority group map to our evidence quite well, it is important countries across Europe and beyond think about how to fairly prioritize people with type 2 diabetes. We recommend that anyone with diabetes takes up the vaccine as soon as it’s available to them.”
Dennis and colleagues analyzed data from three COVID-19 studies in the U.K. OpenSAFELY and QCOVID were population-based studies that reported adjusted age-specific HRs for COVID-19 mortality in diabetes. OpenSAFELY’s data were stratified by HbA1c, but not diabetes type, whereas QCOVID reported age-specific HRs in type 2 diabetes by sex, but did not look at type 1 diabetes. Researchers also collected age-specific HRs associated with type 2 diabetes for people with severe COVID-19 in the COVID-19 Hospitalisation in England Surveillance System (CHESS) cohort. Researchers triangulated the data from all three sources and translated HR estimates into a “COVID age,” which was calculated by adding the additional years of COVID-19 mortality risk to a person’s chronological age where diabetes is present.
The additional COVID-19 mortality risk in diabetes was higher for younger adults than older adults. For a person aged 40 years with type 2 diabetes, the additional mortality risk was equal to 20.4 years, meaning they have a COVID-19 mortality risk similar to an adult aged 60 years without diabetes. The additional risk decreased along with chronological age. Adults aged 50 years with type 2 diabetes have an additional mortality risk of 16.4 years, or equivalent to a person aged 66 years without diabetes. Those aged 60 years with type 2 diabetes have an additional mortality risk of 12.1 years, equivalent to an adult aged 72 years without diabetes. People aged 70 years with type 2 diabetes have a mortality risk of 8.1 additional years, or a COVID-19 mortality risk similar to a person aged 78 years without diabetes.
“Younger people are disproportionately impacted in terms of life-years lost and are of working age, which puts them at potentially higher risk of exposure,” the researchers wrote. “These factors should be considered, alongside the excess relative COVID-19 mortality risk in younger people with diabetes, to ensure that they are appropriately prioritized for vaccination.”
Dennis said the study’s findings should be used by governments to help make decisions on COVID-19 vaccination prioritization.
“A key point is that the risk of middle-aged people with or without type 2 diabetes dying of COVID-19 is really low, so people shouldn’t be unduly worried about their risk,” Dennis said. “It does, however, offer valuable evidence for vaccine prioritization.”
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John M. Dennis, PhD, can be reached at firstname.lastname@example.org.