An epidemiological study to investigate the multifactoral nature of diabetes risk among adults with COVID-19 with a genetic and social determinants of health lens

PROJECT SUMMARY This proposal seeks to enhance our understanding of new-onset diabetes in individuals with COVID-19 by exploring social determinants of health and underlying biology. Both diabetes and COVID-19 disproportionately affect individuals from racial and ethnic minority groups. Further, these individuals experience worse clinical outcomes, including higher rates of mortality compared to non-Hispanic Whites. Some have suggested these observations may be due to differences in comorbidities, home/work environment, or access to care. This study will investigate the 1) prevalence of new-onset diabetes in COVID-19; 2) how social determinants of health influence health outcomes; and 3) the genetic likelihood of developing diabetes. Study results will not only help identify high risk populations, but will also contribute to enhancing health equity, reducing disparities, and promoting better health outcomes. The proposed work will use quantitative methods to address the question. We will conduct a systematic review and meta-analysis to determine the true prevalence of new-onset diabetes in individuals diagnosed with COVID-19. Additionally, we will use prospective survey data from the All of Us database to determine salient factors related to social determinants of health and health outcomes. Last, we will use the All of Us database to conduct genome-wide-association studies and calculate the risk score for diabetes and COVID-19 to examine underlying biologic risk of developing new-onset diabetes. The training plan for this fellowship includes a variety of opportunities to develop and apply knowledge in social determinants of health and analytic skills as well as professional development activities aimed at nurturing a well-rounded nurse scientist. Training opportunities include structured and experiential learning activities to develop substantive and methodological knowledge. Interdisciplinary team-based research experiences and mentorship will complement formal and experiential learning opportunities. A strong mentoring team has been assembled with complementary experts in endocrinology/diabetes, social determinants of health, and statistical analysis. The proposed study and study sponsors are supported by the institutional environment of Boston College Connell School of Nursing which has significant resources to support the proposed project. The mentoring team and institutional environment are well-suited for the successful completion of the proposed project and training plan for this fellowship. This study addresses the NINR's research lens of advancing health equity and social determinants of health research. The proposed work will elucidate the intersection of social and environmental factors with biologic risk factors and their impact on health outcomes. Findings will inform a holistic approach to understanding health disparities and advancing health equity among racial and ethnic minorities affected by diabetes and COVID-19