Persistent poverty, glycemic control and adverse COVID-19 outcomes: a retrospective study using real-world data

Area of Science:

• Public Health
• Epidemiology
• Health Disparities

Background:

• The COVID-19 pandemic revealed significant health disparities linked to socioeconomic factors and chronic conditions like diabetes.
• Persistent poverty areas, defined by long-term economic deprivation, may exacerbate health risks, especially for individuals with diabetes and poor glycemic control.

Purpose of the Study:

• To investigate the independent and combined associations between residing in persistent poverty areas, longitudinal glycemic control in individuals with diabetes, and adverse COVID-19 outcomes.
• To utilize real-world electronic health record data for a comprehensive analysis.

Main Methods:

• Retrospective analysis of 3,681 COVID-19 patients' electronic health records from a large academic health system.
• Categorization of patients based on residence in persistent poverty census tracts and diabetes status/glycemic control (including undiagnosed and poorly controlled T2DM).
• Bayesian multivariable logistic regression models were employed to assess associations, controlling for demographic and social risk factors.

Main Results:

• Patients residing in persistent poverty areas showed increased odds of hospitalization (OR 1.28), ICU admission (OR 1.40), and mortality (OR 1.50).
• Individuals with undiagnosed diabetes had significantly higher odds of hospitalization (OR 3.05) and mortality (OR 1.96).
• Poor glycemic control, particularly undiagnosed diabetes, emerged as a critical risk factor for severe COVID-19 outcomes.

Conclusions:

• Residing in persistent poverty census tracts and having poor glycemic control are independent risk factors for adverse COVID-19 outcomes.
• Targeted management of glycemic control and proactive preventive strategies in persistent poverty areas are crucial for mitigating severe COVID-19 and Long COVID sequelae.