AUTHOR=Ottone Marta , Bartolini Letizia , Bonvicini Laura , Giorgi Rossi Paolo ,  Reggio Emilia COVID-19 working group , Costantini Massimo , Grilli Roberto , Marino Massimiliano , Formoso Giulio , Formisano Debora , Venturi Ivano , Campari Cinzia , Gioia Francesco , Broccoli Serena , Ottone Marta , Pattacini Pierpaolo , Besutti Giulia , Iotti Valentina , Spaggiari Lucia , Seidenari Chiara , Veronesi Licia , Affanni Paola , Colucci Maria Eugenia , Nitrosi Andrea , Foracchia Marco , Colla Rossana , Massari Marco , Ferrari Anna Maria , Pinotti Mirco , Facciolongo Nicola , Lattuada Ivana , Trabucco Laura , Pietri Stefano De , Danelli Giorgio Francesco , Albertazzi Laura , Bellesia Enrica , Canovi Simone , Corradini Mattia , Fasano Tommaso , Magnani Elena , Pilia Annalisa , Polese Alessandra , Incerti Silvia Storchi , Zaldini Piera , Bonelli Efrem , Orsola Bonanno , Revelli Matteo , Salvarani Carlo , Pinto Carmine , Mancuso Pamela , Venturelli Francesco , Vicentini Massimo , Perilli Cinzia , Larosa Elisabetta , Bisaccia Eufemia , Bedeschi Emanuela , Zerbini Alessandro , Rossi Paolo Giorgi 

TITLE=The effect of diabetes on COVID-19 incidence and mortality: Differences between highly-developed-country and high-migratory-pressure-country populations

JOURNAL=Frontiers in Public Health

VOLUME=Volume 11 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.969143

DOI=10.3389/fpubh.2023.969143

ISSN=2296-2565

ABSTRACT=The objective of this study was to compare the effect of diabetes and pathologies potentially related to diabetes on the risk of infection and death from COVID-19 among people from Highly-Developed-Country (HDC), including Italians, and immigrants from the High-Migratory-Pressure-Countries (HMPC). Among the population with diabetes, whose prevalence is known to be higher among immigrants, we compared the effect of body mass index among HDC and HMPC.
A population-based cohort study was conducted, using population registries and routinely collected surveillance data. The population was stratified into HDC and HMPC, according to the place of birth; moreover, a focus was set on the South Asiatic population. Analyses restricted to the population with type-2 diabetes were performed. We reported incidence (IRR) and mortality rate ratios (MRR) and hazard ratios (HR) with 95% confidence interval (CI) to estimate the effect of diabetes on SARS-CoV-2 infection and COVID-19 mortality.
Overall, IRR of infection and MRR from COVID-19 comparing HMPC with HDC were 0.84 (95%CI 0.82-0.87) and 0.67 (95%CI 0.46-0.99), respectively. The effect of diabetes on the risk of infection and death from COVID-19 was slightly higher in the HMPC than in the HDC (HRs for infection: 1.37 95%CI 1.22-1.53 vs. 1.20 95%CI 1.14-1.25; HRs for mortality: 3.96 95%CI 1.82-8.60 vs. 1.71 95%CI 1.50-1.95, respectively). No substantial difference in the strength of the association was observed between obesity or other comorbidities and SARS-CoV-2 infection. Similarly for COVID-19 mortality, HRs for obesity (HRs: 18.92 95%CI 4.48-79.87 vs. 3.91 95%CI 2.69-5.69) were larger in HMPC than in the HDC, but differences could be due to chance. Among the population with diabetes, the HMPC showed similar incidence (IRR: 0.99 95%CI: 0.88-1.12) and mortality (MRR: 0.89 95%CI: 0.49-1.61) to that of HDC individuals. The effect of obesity on incidence was similar in both HDC and HMPC (HRs: 1.73 95%CI 1.41-2.11 among HDC vs. 1.41 95%CI 0.63-3.17 among HMPC), although the estimates were very imprecise. Despite a higher prevalence of diabetes and a stronger effect of diabetes on Covid-19 mortality in HMPC than in the HDC population, our cohort did not show an overall excess risk of COVID-19 mortality in immigrants.