Abstract P154: Diabetes Risk Factor Control and Infection Risk in Older Adults: The ARIC Study

Abstract

Introduction: Diabetes has been tied to infection risk in mechanistic studies. However, the relationship between diabetes and infection hasn't been well documented in epidemiologic studies, especially in vulnerable older adult populations. Hypothesis: We hypothesize that diabetes will be associated with increased risk of inpatient and outpatient infection in older adults. Methods: We conducted a prospective cohort analysis of diabetes and ‘any’ and ‘hospitalized infection’ with data from the Atherosclerosis Risk in Communities (ARIC) study. Infection outcomes were ascertained with ICD9/10 codes from Medicare CMS outpatient claims and hospital discharge diagnoses (follow up from (Visit 5) 2011-2013 to December 31, 2019). We calculated the 8-year cumulative incidence of ‘any’ or ‘hospitalized” infection using Kaplan-Meier analysis. We used Cox regression to examine the association between diabetes and infection and adjusted for confounders. Results: We included 2,154 participants (mean age at Visit 5: 74.4 years, 51.4% female). During median follow up of 2.91 years, there were 1,141 incident infections and 661 incident hospitalizations with infection. Compared to those without diabetes, older adults with diabetes had higher cumulative incidence of any infection (69% vs 63%) and hospitalized infection (36% vs 27%)(Figure).This excess risk remained after adjusting for confounders, with adjusted HR for ‘any’ infection indicating a higher but non-significant risk in diabetic older patients [HR:1.12, 95% CI (0.99, 1.26)], and adjusted HR for ‘hospitalized” infection indicating a significantly higher risk in diabetic older patients [HR:1.37, 95% CI (1.16, 1.63)]. Conclusion: Given the aging American population and COVID-19 pandemic, it is critical to identify factors that increase susceptibility to infection in older adults. Our study suggests diabetes confers an increased risk for hospitalized infection in older adults. Improving diabetes management may reduce infection-related morbidity and mortality.