Strong association between health insurance type and adverse outcomes for pediatric and adolescent patients with type 1 diabetes and COVID-19;Data from the T1D Exchange COVID Registry

ABSTRACT

Introduction: Health insurance coverage type differs significantly by socio-economic status and racial groups in the United States. There is limited data on the association between insurance and the risk of adverse outcomes for patients with pre-existing T1D and COVID19. Objectives: The aim of this study was to determine if publicly insured pediatric and adolescent patients with Type 1 Diabetes (T1D) were more likely to experience adverse outcomes compared to privately insured patients with acute COVID-19 infections. Methods: Data from 575 patients with previously established T1D aged <24 years with acute COVID-19 infections was analyzed from the T1DX-COVID-19 Surveillance Registry. Data for the registry was collected from 52 endocrinology clinics across the U.S, using an online survey tool. Each site completed the survey using electronic medical record (EMR) data between April 2020 and May 2021. Results: Privately insured patients were more likely to identify as Non-Hispanic White than publicly insured patients (63% vs 18%, p<0.001). T1D patients with COVID-19 that were on public insurance reported higher A1c (9.5% vs 7.9%, p<0.001), lower insulin pump use (29% vs 62%, p<0.001), as well as lower continuous glucose monitor (CGM) use (51% vs 77%, p<0.001) compared to privately insurance patients. Publicly insured patients with T1D and COVID-19 were three times more likely to be hospitalized than privately insured patients (Odds Ratio 3.4, 95% Confidence Interval 2.1-5.4). Conclusions: Our data reveals a high rate of hospitalization and DKA among children and adolescents with T1D and COVID19 with public health insurance despite controlling for other potential confounders. This underscores that those on public health insurance are more vulnerable to adverse health outcomes during the COVID19 pandemic. (Table Presented).