COVID-19 Infection and Diabetes Incidence in Native Americans: Supplemental Scope

PROJECT ABSTRACT American Indians and Alaska Natives (Native Americans) have suffered disproportionately during the COVID-19 pandemic with higher rates of infection, hospitalization and mortality from COVID-19 compared to Non-Hispanic Whites. Native Americans also suffer disproportionately from diabetes with nearly 3 times the incidence and 2.3 times the diabetes-related death rate of Non-Hispanic Whites. Growing evidence suggests that COVID-19 infection increases the risk of developing diabetes. Large cohort studies have reported a ~50% increased risk of developing diabetes following COVID-19 infection compared to matched or historic controls without known COVID infection. While these studies offer important insight into the magnitude of risk of new onset diabetes following COVID infection, the setting in which existing studies have been conducted are limited and primarily include US veterans, commercially insured patients enrolled in large US health insurance plans, or community-based settings from countries outside the US. Little is known regarding how this risk varies across diverse populations within the US. Understanding the epidemiologic links between COVID-19 infection and diabetes in Native Americans is critical to address health disparities in this population who face a disproportionate burden of both COVID-19 and diabetes. To measure the association between COVID-19 infection and diabetes risk in Native Americans we will conduct a series of analyses in two distinct data sources: a large, nationally representative clinical database available through Indian Health Services and the Alaska Diabetes Registry with embedded electronic health record data through the Alaska Tribal Health System. Aim 1 will measure the association between COVID-19 infection and risk of incident diabetes risk in Native Americans via a matched, retrospective cohort study using nationwide data from Indian Health Services. Aim 2 will compare the clinical presentation of incident diabetes cases at onset and in the 6 months following diabetes diagnosis by antecedent COVID-19 infection status in a retrospective cohort of individuals using nationwide data from Indian Health Services as well as the comprehensive Diabetes Registry maintained by the Alaska Native Tribal Health Consortium. The proposed studies will provide a comprehensive epidemiologic assessment of the COVID-19-diabetes association in Native Americans, including a nationwide description of COVID-19 infection-related diabetes risk and a deep dive into the clinical presentation of incident diabetes cases. This knowledge will support the continued efforts of Tribal, Federal, State, and community entities to mitigate the impacts of the COVID-19 pandemic in Native Americans and further efforts to address the COVID-19 and diabetes health disparities faced by this population.