COVID-19 impacts and inequities among underserved communities with diabetes

Jennifer L Maizel; Michael J Haller; David M Maahs; Ananta Addala; Rayhan A Lal; Stephanie L Filipp; Matthew J Gurka; Sarah Westen; Brittney N Dixon; Lauren Figg; Melanie Hechavarria; Keilecia G Malden; Ashby F Walker

doi:10.1016/j.jcte.2024.100337

COVID-19 impacts and inequities among underserved communities with diabetes

J Clin Transl Endocrinol. 2024 Mar 19:36:100337. doi: 10.1016/j.jcte.2024.100337. eCollection 2024 Jun.

Authors

Affiliations

¹ Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Department of Public Health, 3300 South University Drive, Fort Lauderdale, FL 33328, USA.
² University of Florida College of Public Health and Health Professions, Department of Health Services Research, Management, and Policy, 1225 Center Drive, Gainesville, FL 32611, USA.
³ University of Florida College of Medicine, Department of Pediatrics, 1600 Southwest Archer Road, Gainesville, FL 32610, USA.
⁴ Stanford University School of Medicine, Department of Pediatrics and Division of Diabetes and Endocrinology, 291 Campus Drive, Stanford, CA 94305, USA.
⁵ Stanford University School of Medicine, Division of Endocrinology, Gerontology, and Metabolism, 291 Campus Drive, Stanford, CA 94305, USA.
⁶ University of Florida College of Public Health and Health Professions, Department of Clinical and Health Psychology, 1225 Center Drive, Gainesville, FL 32611, USA.

Abstract

Background: People with diabetes have higher COVID-19 morbidity and mortality. These risks are amplified for underserved communities including racial/ethnic minorities and people with lower socioeconomic status. However, limited research has examined COVID-19 outcomes specifically affecting underserved communities with diabetes.

Methods: From November 2021 to July 2022, adults with insulin-requiring diabetes at federally qualified health centers in Florida and California (n = 450) completed surveys examining COVID-19 outcomes and demographics. Surveys assessed COVID-19 severity, vaccination uptake, mask-wearing habits, income changes, and healthcare access changes. Surveys also included the full Coronavirus Anxiety Scale (CAS-19). Descriptive statistics were computed for all outcomes. Between-group comparisons for state and race/ethnicity were evaluated via Chi-Squared, Fisher's Exact, Cochran-Mantel-Haenszel, One-Way ANOVA, and t-tests. Logistic regression determined factors associated with COVID-19 vaccination uptake. Data were self-reported and analyzed cross-sectionally.

Results: Overall, 29.7 % reported contracting COVID-19; of those, 45.3 % sought care or were hospitalized. Most (81.3 %) received ≥ 1 vaccine. Hispanics had the highest vaccination rate (91.1 %); Non-Hispanic Blacks (NHBs) had the lowest (73.9 %; p =.0281). Hispanics had 4.63x greater vaccination odds than Non-Hispanic Whites ([NHWs]; 95 % CI = [1.81, 11.89]). NHWs least often wore masks (18.8 %; p <.001). Participants reported pandemic-related healthcare changes (62 %) and higher costs of diabetes medications (41 %). Income loss was more frequent in Florida (76 %; p <.001). NHBs most frequently reported "severe" income loss (26.4 %; p =.0124). Loss of health insurance was more common among NHBs (13.3 %; p =.0416) and in Florida (9.7 %; p =.039). COVID-19 anxiety was highest among NHBs and Hispanics (IQR = [0.0, 3.0]; p =.0232) and in Florida (IQR = [0.0, 2.0]; p =.0435).

Conclusions: Underserved communities with diabetes had high COVID-19 vaccine uptake but experienced significant COVID-19-related physical, psychosocial, and financial impacts. NHBs and those in Florida had worse outcomes than other racial/ethnic groups and those in California. Further research, interventions, and policy changes are needed to promote health equity for this population.

Keywords: COVID-19; Coronavirus; Diabetes; Health Disparities; Health Equity; Pandemic.