Diabetes is associated with increased risk of death in COVID-19 hospitalizations in Mexico 2020: A retrospective cohort study

Background and Aim: The COVID-19 disease course can be thought of as a function of prior risk factors consisting of comorbidities and outcomes. Survival analysis data for diabetic patients with COVID-19 from an up to date and representative sample can increase efficiency in resource allocation. The study aimed to quantify mortality in Mexico for individuals with diabetes in the setting of COVID-19 hospitalization. Methods: This retrospective cohort study utilized publicly available data from the Mexican Federal Government, covering the period from April 14, 2020, to December 20, 2020 (last accessed). Survival analysis techniques were applied, including Kaplan-Meier curves to estimate survival probabilities, log-rank tests to compare survival between groups, Cox proportional hazard models to assess the association between diabetes and mortality risk, and restricted mean survival time (RMST) analyses to measure the average survival time. Results: A total of 402,388 adults age greater than 18 with COVID-19 were used in the analysis. Mean age = 16.16 (SD = 15.55), 214,161 males (53%). Twenty-day Kaplan-Meier estimates of mortality were 32% for COVID-19 patients with diabetes and 10.2% for those without diabetes with log-rank p < 0.01. Univariable analysis showed increased mortality in diabetic patients (hazard ratio [HR]: 3.61, 95% confidence interval [CI]: 3.54-3.67, p < 0.01) showing a 254% increase in death. After controlling for confounding variables, multivariate analysis continued to show increased mortality in diabetics (HR: 1.37, 95% CI: 1.29-1.44, p < 0.01) indicating a 37% increase in death. Multivariable RMST at Day 20 showed in Mexico, hospitalized COVID-19 patients were associated with less mean survival time by 2.01 days (p < 0.01) and a 10% increased mortality (p < 0.01). Conclusions: In the present analysis, COVID-19 patients with diabetes in Mexico had shorter survival times. Further interventions aimed at improving comorbidities in the population, particularly in individuals with diabetes, may contribute to better outcomes in COVID-19 patients.