Multi-site analysis of COVID-19 and new-onset diabetes reveals need for improved sensitivity of EHR-based COVID-19 phenotypes-a DiCAYA Network analysis.
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Conderino Sarah, Kirchner H Lester, Thorpe Lorna E, Divers Jasmin, Hirsch Annemarie G, Nordberg Cara M, Schwartz Brian S, Zhang Lu, Cai Bo, Rudisill Caroline, Obeid Jihad S, Liese Angela, Allen Katie S, Dixon Brian E, Crume Tessa, Dabelea Dana, Burgett Shawna, Bellatorre Anna, Shao Hui, Bian Jiang, Guo Yi, Bost Sarah, Lyu Tianchen, Reynolds Kristi, Mefford Matthew T, Zhou Hui, Zhou Matt, Lustigova Eva, Utidjian Levon H, Maltenfort Mitchell, Kamboj Manmohan, Mendonca Eneida A, Hanley Patrick, Zaganjor Ibrahim, Pavkov Meda E, Rosenman Marc, Titus Andrea R, DiCAYA Study Group
Аннотация
MATERIALS AND METHODS: In our retrospective case study from the DiCAYA Network, SARS-CoV-2 was identified using labs and diagnoses from June 1, 2020 to December 31, 2021. Patients were followed through December 31, 2022 for new diabetes diagnoses. Sites examined incident diabetes by COVID-19 status using Cox proportional hazards models. Results were pooled in meta-analyses. A bias analysis examined potential impact of COVID-19 misclassification scenarios on results, guided by hypotheses that sensitivity would be <50% and would be higher among those who developed diabetes.
RESULTS: Prevalence of documented COVID-19 was low overall and variable across sites (children: 4.4%-7.7%, young adults: 6.2%-22.7%). Individuals with documented COVID-19 were at higher risk of incident diabetes compared to those with no documented infection, but results were heterogeneous across sites. Findings were highly sensitive to COVID-19 misclassification assumptions. Observed results could be biased away from the null under several differential misclassification scenarios.
DISCUSSION: Although EHR-based documentation of COVID-19 was associated with incident diabetes, COVID-19 phenotypes likely had low sensitivity, with considerable variation across sites. Misclassification assumptions strongly impacted interpretation of results.
CONCLUSION: Given the potential for low phenotype sensitivity and misclassification, caution is warranted when interpreting analyses of COVID-19 and incident diabetes using clinical or administrative databases.