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Updated: Oct 28, 2025
A High-Throughput Multiplexed Screening for Type 1 Diabetes, Celiac Diseases, and COVID-19
Published on: July 5, 2022
Risk Factors Associated with COVID-19 Hospitalization and Mortality: A Large Claims-Based Analysis Among People with
Kristina S Boye1, Elif Tokar Erdemir2, Nathan Zimmerman3
1Eli Lilly and Company, Indianapolis, IN, USA.
Insights
Type 2 diabetes (T2D) increases COVID-19 hospitalization and mortality risk. Comorbidities like dementia and certain diabetes medications impact risk, informing public health strategies for high-risk T2D patients.
Area of Science:
- Epidemiology
- Public Health
- Clinical Research
Background:
- Diabetes Mellitus (DM) is a significant risk factor for severe COVID-19 outcomes.
- Understanding specific risk factors for COVID-19 hospitalization and mortality in diabetic populations is crucial.
Purpose of the Study:
- To identify risk factors for COVID-19 hospitalization and in-hospital mortality in a nationwide US population.
- To specifically analyze these risk factors within the type 2 diabetes (T2D) subgroup.
Main Methods:
- Retrospective analysis of a de-identified nationwide administrative claims database (Jan 2019-Jul 2020).
- Inclusion of SARS-CoV-2 test results and COVID-19 inpatient data.
- Logistic regression modeling to assess risk factors, with subgroup and sensitivity analyses for T2D.
Main Results:
- Type 2 Diabetes (T2D) was associated with increased COVID-19 hospitalization and mortality.
- Consistent risk factors for hospitalization included age, male sex, dementia, metastatic tumor, congestive heart failure, paraplegia, and metabolic disease.
- Among T2D patients, biguanides (metformin) correlated with lower hospitalization odds, while sulfonylureas and insulins correlated with higher odds.
Conclusions:
- T2D is an independent risk factor for COVID-19 complications.
- Comorbidities pose similar hospitalization risks across general and T2D populations.
- Diabetes medications may indicate differential risk, informing targeted public health interventions for high-risk T2D individuals.
Introduction:
Diabetes has been identified as a high-risk comorbidity for COVID-19 hospitalization. We evaluated additional risk factors for COVID-19 hospitalization and in-hospital mortality in a nationwide US database.
Methods:
This retrospective study utilized the UnitedHealth Group Clinical Discovery Database (January 1, 2019-July 15, 2020) containing de-identified nationwide administrative claims, SARS-CoV-2 laboratory test results, and COVID-19 inpatient admissions data. Logistic regression was used to understand risk factors for hospitalization and in-hospital mortality among people with type 2 diabetes (T2D) and in the overall population. Robustness of associations was further confirmed by subgroup and sensitivity analyses in the T2D population.
Results:
A total of 36,364 people were identified who were either SARS-CoV-2+ or hospitalized for COVID-19. T2D was associated with increased COVID-19-related hospitalization and mortality. Factors associated with increased hospitalization risk were largely consistent in the overall population and the T2D subgroup, including age, male sex, and these top five comorbidities: dementia, metastatic tumor, congestive heart failure, paraplegia, and metabolic disease. Biguanides (mainly metformin) were consistently associated with lower odds of hospitalization, whereas sulfonylureas and insulins were associated with greater odds of hospitalization among people with T2D.
Conclusion:
In this nationwide US analysis, T2D was identified as an independent risk factor for COVID-19 complications. Many factors conferred similar risk of hospitalization across both populations; however, particular diabetes medications may be markers for differential risk. The insights on comorbidities and medications may inform population health initiatives, including prevention efforts for high-risk patient populations such as those with T2D.
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