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

The coronavirus disease 2019 (COVID-19) pandemic has highlighted the profound impact of diabetes and neighborhood environments on health outcomes. Persistent poverty areas, characterized by long-standing economic deprivation, may contribute to increased risk for severe COVID-19 outcomes, particularly among individuals with poor glycemic control. This study investigated the associations between persistent poverty, longitudinal glycemic control by diabetes status, and adverse COVID-19 outcomes using real world data.

We conducted a retrospective analysis using electronic health record (EHR) data from a large Academic health system. The sample included 3,681 adults diagnosed with COVID-19 between March 2020 and January 2021, with available HbA1c and neighborhood level data. Residence in census-tract level persistent poverty areas was categorized as yes vs. no while diabetes status and glycemic control were categorized into five groups based on history of diagnosis and HbA1c measured up to three years prior to infection. Bayesian multivariable logistic regression models assessed independent and multiplicative associations between living in a persistent poverty census tract, glycemic control by diabetes status, and adverse COVID-19 outcomes [e.g. hospitalization, intensive care unit (ICU) admission, and death during hospitalization], controlling for demographics and other social risk factors.

Among 3,681 patients (mean age 54 years; 60% female; 47% Black), 41.4% were hospitalized, 19.2% were admitted to the ICU, and 6.2% died. Overall, 18.0% resided in persistent poverty areas, 36.2% had diabetes [16.6% undiagnosed diabetes, and 11.1% poorly controlled T2DM]. Residing in persistent poverty areas was associated with an increased risk of hospitalization (OR 1.28, 95% CI: 1.02-1.61), ICU admission (OR 1.40, 95% CI: 1.08-1.80), and mortality (OR 1.50, 95% CI: 1.01-2.22). Patients with undiagnosed diabetes had an increased risk of hospitalization (OR 3.05, 95% CI 2.41-3.86) and mortality (OR 1.96, 95% CI: 1.30-2.97).

This study highlights that residing in a persistent poverty census tract as well as poor glycemic control independently contribute to COVID-19 outcomes. Ongoing management of glycemic control and early preventive strategies in persistent poverty areas may mitigate adverse outcomes in COVID-19 infection and subsequent sequalae like Long COVID.