Impact of the COVID-19 Pandemic on Children and Adolescents with New-Onset Type 1 Diabetes

Table 3

Relative risk of type 1 diabetes after SARS-CoV-2 infection.

Study regions	Data sources	Age (years)	Pandemic period	(Pre-)pandemic control period	Cohort with documented SARS-CoV-2 infection		Cohort without documented SARS-CoV-2 infection or with other respiratory infection (RI)		With SARS-CoV-2 vs (without SARS-CoV-2 or with other RI)	p
					“Observed”		“Expected”		“Observed vs expected”
					T1D cases	T1D incidence (95% CI)^1	T1D cases	T1D incidence (95% CI)^1	Relative risk 95% CI^2
Barret 2022^3 USA	HealthVerity database	<18	01.03.20–28.06.21	01.03.20–28.06.21	1120^4	399 (376, 423)^4	853^5	304 (284, 324)^5	1.310 (1.200, 1.440)^7	<0.05
	IQVIA database	<18	01.03.20–26.02.21	01.03.20–26.02.21	68^4	316 (241, 391)^4	132^5	118 (98, 139)^5	2.660 (1.980, 3.560)^7	<0.05
				01.03.17–26.02.18			227^6	126 (109, 142)^6	2.160 (1.640, 2.860)^7	<0.05
Kendall 2022	TriNetX analytics platform	≤18	01.03.20–31.12.21	01.03.20–31.12.21	56^8	19.6 (15.1, 25.5)^8	30^8	10.5 (7.3, 15.0)^8	1.960 (1.260, 3.060)^7	<0.05
	Electronic health records				91^9	31.9 (25.9, 39.1)^9	46^9	16.1 (12.1, 21.5)^9	2.100 (1.480, 3.000)^7	<0.05
	74 healthcare organization				123^10	43.1 (36.1, 51.4)^10	72^10	25.2 (20.0, 31.8)^10	1.830 (1.360, 2.440)^7	<0.05
McKeigue 2022 UK, Scotland	COVID-19 database, diabetes registry	<35	01.03.20–22.11.21^11	01.01.15–31.12.21^11	31^12	29.0 (20.4, 41.3)^12	1.005^13	9.1 (8.6, 9.7)^13	2.620 (1.810, 3.780)^7	<0.001
					38^13	8.7 (6.3, 11.9)^14			0.860 (0.620, 1.210)^7	0.4
Pietropaolo 2022	TriNetX COVID-19 research network, electronic medical records, 60 healthcare organization	≤18	01.01.20–11.06.21	01.01.20–11.06.21	26	23.6 (16.1, 34.7)	30^15	27.2 (19.0, 39.0)^15	0.867 (0.513, 1.466)^16	0.595
		19–30			43	26.3 (19.5, 35.4)	23^15	14.0 (9.3, 21.1)^15	1.869 (1.127, 3.106)^16	0.014
Qeadan 2022 USA	CERNER REAL-WORLD-DATA electronic health records	<18	01.08.21–30.09.21^8	01.08.21–30.09.21^8	598^17	159.4 (147.1, 172.7)^17	5376^18	98.7 (96.1, 101.3)^18	1.616 (1.485, 1.758)	<0.001
		18–35			1003^17	181.4 (170.5, 193.0)^17	9864^18	186.7 (183.0, 190.4)^18	0.972 (0.911, 1.037)	0.390
		≥36			3304^17	232.8 (225.0, 240.9)^17	18566^18	149.5 (147.4, 151.7)^18	1.557 (1.500, 1.616)	<0.001
		All ages			5163^17	207.4 (201.8, 213.1)^17	36348^18	146.5 (145.0, 148.1)^18	1.415 (1.375, 1.457)	<0.001
Xie 2022	US Department of Veterans	All ages	01.03.20–30.09.21	01.03.20–30.09.21	49	28 (19, 41)	643^19	17 (16, 19)^19	1.647 (1.029, 2.637)	<0.001
USA	Affair national database			01.03.18–30.09.19			828^19	22 (20, 23)^19	1.273 (0.808, 2.005)	0.101

Figures in italics were recalculated based on data reported in the original articles. ¹Per 100,000 person-years, if not stated otherwise. ²Estimated as ratio of the incidence in the cohort with documented SARS-CoV-2 infection and that in the cohort without documented SARS-CoV-2 infection, if not stated otherwise. ³No differentiation between type 1 and type 2 diabetes. ⁴Number of cases or incidence in the cohort with documented SARS-CoV-2 infection more than 30 days before diabetes diagnosis. ⁵Number of cases or incidence in the pandemic comparison cohort without documented SARS-CoV-2 infection. ⁶Number of cases or incidence in prepandemic comparison cohort with documented respiratory infection. ⁷Estimated hazard ratio. ⁸Number of cases or cumulative incidence with T1D diagnosis with 1 month after SARS-CoV-2 infection. ⁹Number of cases or cumulative incidence with T1D diagnosis with 3 month after SARS-CoV-2 infection. ¹⁰Number of cases or cumulative incidence with T1D diagnosis with 6 month after SARS-CoV-2 infection. ¹¹Follow-up period. ¹²Number of cases or incidence per 100,000 person-days in the cohort with documented SARS-CoV-2 infection within 30 days before diabetes diagnosis. ¹³Number of cases or incidence per 100,000 person-days in comparison cohort without documented SARS-CoV-2 infection. ¹⁴Number of cases or incidence per 100,000 person-days in the comparison cohort with documented SARS-CoV-2 infection more than 30 days before diabetes diagnosis. ¹⁵Number of cases or incidence in the comparison cohort without documented SARS-CoV-2 infection. ¹⁶Estimated risk ratio from propensity score-matched analysis (reciprocal values of figures reported in Pietropaolo 2022). ¹⁷Number of cases or cumulative incidence in the cohort with documented SARS-CoV-2 infection. ¹⁸Number of cases or cumulative incidence in the cohort without documented SARS-CoV-2 infection. ¹⁹Number of cases or incidence in the cohort without documented SARS-CoV-2 infection.