The impact of race/ethnicity on the clinical outcomes of people with type 2 diabetes admitted to hospital with COVID-19: an observational multi-national analysis

Aims: To describe the relationship between race/ethnicity and adverse outcomes related to coronavirus disease 2019 (COVID-19) in adults with T2DM admitted to hospital in the UK, France and USA. Methods: Study data from the UK ABCD nationwide COVID- 19 audit, the French CORONADO nationwide initiative and the USA AMERICADO multi-centre study were analysed to assess the association between race/ethnicity and severe COVID-19. Severe COVID-19 was defined as death in hospital and/or admission to the intensive care unit (ICU). Logistic regression models were used to generate age-adjusted odds ratios. Results: Data from 3,471 patients in the ABCD audit, from 2,451 CORONADO patients and from 9,321 AMERICADO patients admitted with COVID-19 and T2DM were analysed. Race/ethnicity data were available for 3,410 (98%), 2,173 (89%) and 8,893 (95%) patients, respectively. In the UK ABCD audit cohort, Asian and Black race/ethnicity were associated with an increased risk of death/ICU admission compared to White when adjusted for age and sex (OR 2.14; 1.38-3.29 and OR 2.09; 1.17-3.74, respectively). When adjusted for additional confounders the association was stronger (Asian OR 2.88; 1.72-4.82 and Black OR 2.20; 1.12-4.30). In the CORONADO cohort Middle Eastern/North African race/ethnicity was protective against death/ICU admission (OR 0.57; 0.36-0.91). There was no association between ethnicity and death alone in the AMERICADO dataset. Conclusion: In those with T2DM admitted to hospital with COVID-19, a non-White race/ethnicity was associated with higher risk of death/ICU admission in the UK ABCD data but not in French CORONADO or USA AMERICADO datasets. Further research is required to improve our understanding of the observed discrepancies in outcomes.