Among individuals who die of COVID-19, is the percentage who had diabetes actually higher than in those dying of other viral infections?

BACKGROUND: Early in the COVID-19 pandemic, mainstream news outlets reported that 30-40% of all coronavirus deaths in the United States occurred among individuals with diabetes. This statistic happens to reflect the approximate prevalence of diabetes in older adults, the age group at highest risk for mortality from COVID-19. To provide greater context to this statistic, we sought to quantify both the proportion of decedents from COVID-19 and from influenza who had diabetes. METHODS: For assessing COVID-19 decedents who had diabetes, we used the National COVID Cohort Collaborative (N3C) data enclave, a nationally-representative, harmonized, and de-identified electronic health record database. For assessing influenza decedents who had diabetes, we used Medicare data. We restricted the N3C sample to > 65 years to align with Medicare eligibility. RESULTS: Among older adults with inpatient mortality due to COVID-19, 46.6% (95% CI: 46.1-47.0) had diabetes. Among older adults with inpatient mortality from influenza, the crude percent with diabetes was 61.2%. When age-standardized to match the N3C COVID-19 data, the percentage of influenza decedents with diabetes was 63.1% (95% CI: 59.1-67.1). CONCLUSIONS: Among older adults with inpatient mortality from respiratory viruses, a very large proportion had diabetes before infection: 63% of influenza decedents and 47% of COVID-19 decedents. Thus, a high proportion of decedents having diabetes is not new or unique to COVID-19. These findings highlight the value of using available data to contextualize health communication to the public.