The burden of COVID-19 in hospitalized people with diabetes mellitus in Brazil: Insights from four years of the pandemic.
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is more severe in people with diabetes mellitus due to immune dysfunction, exacerbated inflammation and increased risk of co-morbidities and mortality. In this context, this study aims to analyse the epidemiological profile of hospitalized people with diabetes mellitus and COVID-19 in Brazil over 4 years of the pandemic.
The epidemiological analysis was conducted using data from the Open-Data-SUS (Sistema Único de Saúde, Brazilian Unified Health System) platform (Brazilian Ministry of Health) covering the period from March 2020 to March 2024. Data were processed in Statistical Package for the Social Sciences software, with missing values imputed using XLSTAT. Variables included demographic profile, viral infection, co-morbidities, clinical signs and symptoms, intensive care unit (ICU) admission and mechanical ventilation, and outcomes. Statistical analyses comprised bivariate and multivariable logistic regression with a 5% significance level, focusing on two primary comparisons: the risk of death and the likelihood of classification as diabetes mellitus. The study protocol was approved by the institutional ethics committee.
Among 2,078,062 people hospitalized with SARS-CoV-2 in Brazil, 22.2% (N = 461,647) had diabetes mellitus, with marked regional heterogeneity in both prevalence and mortality. Overall mortality was 32.9% (N = 683,088). Diabetes mellitus was not only highly prevalent but also emerged as an independent risk factor for in-hospital death, significantly increasing mortality odds (OR = 1.178; 95% confidence interval [95% CI] = 1.168-1.188), as well as higher likelihood of ICU admission (OR = 1.102; 95% CI = 1.093-1.112) and invasive mechanical ventilation (OR = 1.102; 95% CI = 1.087-1.118). Older age, female sex and self-identification as Black, mixed-race or Asian were also strongly associated with diabetes mellitus. The presence of co-morbidities, such as cardiopathy (heart disease), kidney disease, obesity, liver disease, and neurological disorders further amplified the risk of poor outcomes. Regarding vaccination, most people were unvaccinated, and while COVID-19 vaccination showed a modest association with DM diagnosis, it consistently reduced the risk of death (OR = 0.588; 95% CI = 0.583-0.594). Conversely, nosocomial infection substantially increased mortality risk, despite presenting a divergent pattern in relation to diabetes mellitus in adjusted models. Clinical symptoms most strongly associated with death included dyspnoea, respiratory discomfort and peripheral oxygen saturation below 95%. Hospital management variables were decisive: ICU admission and ventilatory support, especially invasive mechanical ventilation (OR = 12.933; 95% CI = 12.752-13.115), markedly increased mortality. Overall, advanced age remained the strongest predictor, with individuals older than 85 years experiencing more than a 30-fold increased risk of death compared with younger groups (OR = 32.840; 95% CI = 30.840-34.969).
Diabetes mellitus is an independent predictor of worse outcomes in hospitalized people with COVID-19 in Brazil. Mortality is strongly influenced by age, co-morbidities and severity markers, while vaccination provides substantial protection.
The epidemiological analysis was conducted using data from the Open-Data-SUS (Sistema Único de Saúde, Brazilian Unified Health System) platform (Brazilian Ministry of Health) covering the period from March 2020 to March 2024. Data were processed in Statistical Package for the Social Sciences software, with missing values imputed using XLSTAT. Variables included demographic profile, viral infection, co-morbidities, clinical signs and symptoms, intensive care unit (ICU) admission and mechanical ventilation, and outcomes. Statistical analyses comprised bivariate and multivariable logistic regression with a 5% significance level, focusing on two primary comparisons: the risk of death and the likelihood of classification as diabetes mellitus. The study protocol was approved by the institutional ethics committee.
Among 2,078,062 people hospitalized with SARS-CoV-2 in Brazil, 22.2% (N = 461,647) had diabetes mellitus, with marked regional heterogeneity in both prevalence and mortality. Overall mortality was 32.9% (N = 683,088). Diabetes mellitus was not only highly prevalent but also emerged as an independent risk factor for in-hospital death, significantly increasing mortality odds (OR = 1.178; 95% confidence interval [95% CI] = 1.168-1.188), as well as higher likelihood of ICU admission (OR = 1.102; 95% CI = 1.093-1.112) and invasive mechanical ventilation (OR = 1.102; 95% CI = 1.087-1.118). Older age, female sex and self-identification as Black, mixed-race or Asian were also strongly associated with diabetes mellitus. The presence of co-morbidities, such as cardiopathy (heart disease), kidney disease, obesity, liver disease, and neurological disorders further amplified the risk of poor outcomes. Regarding vaccination, most people were unvaccinated, and while COVID-19 vaccination showed a modest association with DM diagnosis, it consistently reduced the risk of death (OR = 0.588; 95% CI = 0.583-0.594). Conversely, nosocomial infection substantially increased mortality risk, despite presenting a divergent pattern in relation to diabetes mellitus in adjusted models. Clinical symptoms most strongly associated with death included dyspnoea, respiratory discomfort and peripheral oxygen saturation below 95%. Hospital management variables were decisive: ICU admission and ventilatory support, especially invasive mechanical ventilation (OR = 12.933; 95% CI = 12.752-13.115), markedly increased mortality. Overall, advanced age remained the strongest predictor, with individuals older than 85 years experiencing more than a 30-fold increased risk of death compared with younger groups (OR = 32.840; 95% CI = 30.840-34.969).
Diabetes mellitus is an independent predictor of worse outcomes in hospitalized people with COVID-19 in Brazil. Mortality is strongly influenced by age, co-morbidities and severity markers, while vaccination provides substantial protection.
Authors
Camargo Camargo, Siqueira Siqueira, Marques Marques, Mello Mello, Marson Marson
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