COVID-19 leading cause of death in people with diabetes in fourth quarter of 2020
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The proportion of deaths attributed to COVID-19 in people with diabetes in the U.S. in the last 3 months of 2020 was slightly higher than the percentage of people who died due to cardiovascular disease or diabetes, according to study data.
In a letter published in Diabetes Care, researchers found the rate of all-cause mortality in people with diabetes increased from the third quarter of 2019 through the fourth quarter of 2020, with the higher rate primarily due to a sharp increase in COVID-19 deaths.
“All-cause mortality for diabetes remained stable before the COVID-19 pandemic but surged abruptly during the COVID-19 pandemic,” Donghee Kim, MD, PhD, social sciences research scholar in the department of gastroenterology and hepatology at Stanford University School of Medicine, and colleagues wrote. “While there was no significant increase in diabetes- or CVD-related mortality among individuals with diabetes, the proportion of COVID-19-related mortality among individuals with diabetes sharply increased to about 25%, matching the proportion of deaths due to CVD or diabetes.”
Researchers analyzed national mortality records from the National Vital Statistics System from 2017 to 2020. Data were collected for adults aged 20 years or older with diabetes who died during the study period. All-cause mortality and cause-specific mortality for CVD, cancer, diabetes, renal disease, accidents and COVID-19 were included. Quarterly age-specific mortality was calculated by dividing the number of deaths by the total U.S. census population for each year. Quarterly percentage change and average percent change was used to measure mortality trends every 3 months.
There were 1,218,968 deaths in people with diabetes during the study period, of which the underlying cause was CVD in 373,802, diabetes in 358,439, cancer in 124,881, COVID-19 in 62,595 and renal disease in 2,310.
All-cause mortality was stable from the start of 2017 to third quarter of 2019; however, from the third quarter of 2019 until the end of 2020, all-cause mortality rose by a mean of 9.6% per quarter.
Rates of mortality due to CVD, diabetes and renal disease were similar before the COVID-19 pandemic compared with during the pandemic. Cancer-related mortality increased by a mean of 3.9% per quarter during the pandemic. COVID-19-related mortality rates among people with diabetes increased from 0.4 per 100,000 people in the first quarter of 2020 to 9.7 per 100,000 people in the fourth quarter. The percentage of deaths attributed to COVID-19 in people with diabetes increased from 1.3% in the first quarter of 2020 to 24.7% in the fourth quarter. The percentage of deaths in people with diabetes attributed to COVID-19 in the last 3 months of 2020 were slightly higher than deaths attributed to CVD (24%) and diabetes (24.1%).
“COVID-19-related mortality for at-risk populations, such as those with diabetes, who are more susceptible to a dysregulated inflammatory response or cytokine storm, is up to fourfold higher,” the researchers wrote. “Although obtaining the underlying or contributing cause of death from the death certificate may have the potential for underestimation and misclassification, it is unlikely that coding alone accounted for the temporal trends in diabetes-related death.”
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