Diabetes may be factor in worse COVID-19 outcomes in minority communities

Disparities in diabetes care may be contributing to the higher rates of hospitalization and death from COVID-19 among racial and ethnic minority groups, according to a newly published article.

Writing in the journal Diabetes Care, researchers from the US and UK reviewed existing literature comparing the prevalence and impact of COVID-19 and its comorbidities—including diabetes—among ethnic minority communities, and between those communities and whites. They cite a UK study of people with Type 1 diabetes showing that individuals from South Asian, Black, mixed, and other ethnic groups had “significantly higher” mortality risk from COVID-19 compared with white populations.

The same study showed that for people with Type 2 diabetes, the risk of in-hospital mortality was greater among Asian, Black and people of mixed ethnicity, although not among other groups in the study such as Vietnamese and Japanese.

Similarly, a multi-site observational U.S. study of COVID-19 patients with Type 1 diabetes showed that Black and Hispanic people were, on average, 3.63 times more likely to be hospitalized than non-Hispanic white patients. While results from the few existing studies of COVID-19 among ethnic minority populations are mixed, the authors say, “there is some suggestion that rates of hospitalization and mortality are higher than those of White populations.”

The authors also summarize results of studies looking at factor that may cause worse COVID-19 outcomes among ethnic minorities. These include:

• Increased exposure to the disease due to minorities being overrepresented in occupations classified as essential, especially among health care workers;
• Increased vulnerability to COVID-19, resulting from a higher prevalence of comorbid conditions in ethnic minority populations;
• Socioeconomic factors, such as overcrowded housing and lack of access to health care;
• Less effective measures for limiting community spread of COVID, due to language barriers, poor uptake or access to screening, structural discrimination, and lack of trust in the health care system; and
• Biological differences. The authors note that in studies identifying risk for COVID-19 in Black, Hispanic or other minority ethnic groups, the risk remains even after adjusting for comorbidities and socioeconomic factors. “This suggests there are biological differences underlying differential responses of ethnicity to COVID-19,” they write.

The researchers observe that many of the same factors that contributed to high rates of diabetes among ethnic minorities before the pandemic also caused the disease to disproportionately affect these groups, and therefore need to be addressed.

Among these are a need for more affordable housing, equal access to educational and employment opportunities, and reducing food insecurity. 

“Only by taking a long-term, holistic view of health and health care will we, and particularly our most vulnerable populations, be better able to weather future pandemics,” they conclude.