Everyone has been impacted by COVID-19’s effects in some way, as millions of people in the UK have had COVID-19 since the pandemic began. Of those who got COVID-19, people of certain ethnicities and those who have type II diabetes were found to have an increased risk of having more severe outcomes compared to their counterparts. The aim of this study is to look further into examining ethnic differences in the risk of developing COVID-19 and Post-COVID Syndrome (PCS) among people with type 2 diabetes.
There are 2 research questions that will be studied in this project. The first will look at ethnic differences in the risk of developing COVID-19 in people with type 2 diabetes. The second research question will look at ethnic differences in the risk of developing Post-Covid Syndrome in people with type 2 diabetes who have experienced COVID-19. Through descriptive and analytical methods, we will try to understand the impact one’s ethnicity can have on COVID-19 and PCS, while also examining what other factors may impact our results, like age, biological sex, education status, and more. It is the hope that with this project there will be better understanding of PCS and COVID-19 for people of different ethnic backgrounds and those with type 2 diabetes so that more appropriate care can be given in the future and to understand where further research needs to be done.
This pandemic has affected people globally. Within the UK over 18 million people have had COVID-19, with risk of severe COVID-19 highest in minority ethnic groups and people with chronic conditions such as type II diabetes. The aim of this prospective cohort study will be to examine ethnic differences in COVID-19 and Post-COVID Syndrome among people with type 2 diabetes in the United Kingdom.
Firstly, we will examine ethnic differences in the risk of COVID-19 amongst people with type 2 diabetes. Secondly, we will examine ethnic differences in the risk of Post-COVID Syndrome and related sequalae in a sub-population of people with type II diabetes who have also been diagnosed with COVID-19. Through cross-tabulation, Mantel Haenszel Odds, and Cox proportional hazards regression, we will examine these relationships using STATA SE 17. Additionally, a priori confounders, like age, biological sex, index of multiple deprivation, and possible effect modifiers, like COVID-19 vaccination status, will be assessed to understand their impact on the relationship between ethnicity and COVID-19.This project will improve understanding of PCS and COVID-19 for people from different ethnic backgrounds with type 2 diabetes, resulting in more appropriate future care for ethnically diverse populations and identifying priorities for healthcare policy, resource allocation, pandemic preparedness, and future research.
The study will be conducted using data from CPRD GOLD and AURUM linked to HES APC, IMD, and ONS Death Registration Data. For the primary analysis, diagnoses of COVID-19 and Post-COVID Syndrome will be derived from primary care records only. For the sensitivity analysis, diagnosis of COVID-19 and Post-COVID Syndrome will be derived from both primary care records and HES APC data. The analysis will be conducted separately in GOLD and AURUM and results will be pooled from both data sources for presentation, publication, and wider dissemination.
We will use CPRD GOLD and AURUM in our analysis. We currently only have AURUM data up to June 2021 available for analysis at short notice. Because this project is in fulfillment of an MSc degree, all analysis must be completed by July 2022. Furthermore, as the primary outcome of this study is long/post COVID-19, the June 2021 Aurum dataset will not contain enough outcomes to be well powered for this research question.
In order to meet the deadlines required by the MSc degree, we will start immediately with an analysis of CPRD GOLD (which is available now and goes up to March 2022) and replicate the analysis in CPRD AURUM at a later date when our CPRD Fob Holder can download the data for us (approx late July-August 2022). The analyses from both datasets will be pooled and presented together when preparing the results for presentation, publication, and wider dissemination.
Outcomes:
1) Incident Covid-19
Will be defined as a confirmed diagnosis of COVID-19 in in CPRD GOLD and AURUM (main analysis) and/or a hospital admission where COVID-19 is the primary diagnosis (secondary analysis restricted to those with linked HES-APC data).
2) Incident Post-COVID-19 syndrome
Post-COVID-19 syndrome will be defined using read codes for Post-COVID-19 and Long COVID in CPRD GOLD and AURUM which must occur at least 12 weeks after the initial COVID-19 diagnosis as defined above
3) Chronic disease sequalae of COVID-19 defined using read codesin CPRD GOLD and AURUM
I. Fatigue
II. Lung Disease (ie. Pulmonary embolism, shortness of breath, chest pain)
III. Cardiovascular Disease
IV. Post viral myocarditis
V. Joint pain
VI. Diabetic Ketoacidosis
Rohini Mathur - Chief Investigator - London School of Hygiene & Tropical Medicine ( LSHTM )
Emma Roy - Corresponding Applicant - London School of Hygiene & Tropical Medicine ( LSHTM )
Rohini Mathur - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation