Effects of the COVID-19 Lockdown on HbA1c Levels of Ethnic Minorities and Low-income Groups with Type 2 Diabetes in Israel.

Abstract

To investigate the impact of low socioeconomic status (SES) and/or membership in ethnic minority has on HbA1c before and during the COVID-19 lockdown. A retrospective cohort study was conducted between March 2019 and March 2021, based on data from electronic medical records of 17,072 patients with type-2 diabetes, collected by Clalit (Israel's largest health maintenance organization). Low SES was compared to high and ethnic minorities (Arabs and ultra-Orthodox Jews) were compared to the general Israeli population of mostly Jewish, but not ultra-Orthodox, Israeli citizens. Quantile regressions were used to examine the impact of SES and ethnic minority membership on HbA1c levels in the 0.10, 0.25, 0.50, 0.75, 0.90 quantiles before and during the lockdown. In the pre-lockdown period, patients with type-2 diabetes of low versus high SES, and Arabs versus the general population, had higher HbA1c. During the lockdown HbA1c levels of low versus high SES rose significantly in the 0.10 and 0.90 quantiles, and among Arabs HbA1c levels rose significantly across all quantiles, with a remarkable increment in the 0.90 quantile (from 0.316% in the pre-lockdown period to 0.730% in the lockdown period). Ultra-Orthodox Jewish diabetic patients had a marginally higher mean HbA1C level regardless of the period. Quantile regressions did not reveal a significant difference between the ultra-Orthodox Jewish and the general population. The lockdown exacerbated disparities in glycemic control between low and high SES individuals and between Arab minority and the general population.