Abstract
BACKGROUND: Obesity may contribute to adverse outcomes in coronavirus disease 2019 (COVID-19). However, studies of large, broadly generalizable patient populations are lacking, and the effect of body mass index (BMI) on COVID-19 outcomes— particularly in younger adults—remains uncertain. METHODS: We analyzed data from patients hospitalized with COVID-19 at 88 US hospitals enrolled in the American Heart Association’s COVID-19 Cardiovascular Disease Registry with data collection through July 22, 2020. BMI was stratified by World Health Organization obesity class, with normal weight prespecified as the reference group. RESULTS: Obesity, and, in particular, class III obesity, was overrepresented in the registry in comparison with the US population, with the largest differences among adults ≤50 years. Among 7606 patients, in-hospital death or mechanical ventilation occurred in 2109 (27.7%), in-hospital death in 1302 (17.1%), and mechanical ventilation in 1602 (21.1%). After multivariable adjustment, classes I to III obesity were associated with higher risks of in-hospital death or mechanical ventilation (odds ratio, 1.28 [95% CI, 1.09–1.51], 1.57 [1.29–1.91], 1.80 [1.47–2.20], respectively), and class III obesity was associated with a higher risk of in-hospital death (hazard ratio, 1.26 [95% CI, 1.00–1.58]). Overweight and class I to III obese individuals were at higher risk for mechanical ventilation (odds ratio, 1.28 [95% CI, 1.09–1.51], 1.54 [1.29–1.84], 1.88 [1.52–2.32], and 2.08 [1.68–2.58], respectively). Significant BMI by age interactions were seen for all primary end points (P-interaction<0.05 for each), such that the association of BMI with death or mechanical ventilation was strongest in adults ≤50 years, intermediate in adults 51 to 70 years, and weakest in adults >70 years. Severe obesity (BMI ≥40 kg/m2) was associated with an increased risk of in-hospital death only in those ≤50 years (hazard ratio, 1.36 [1.01–1.84]). In adjusted analyses, higher BMI was associated with dialysis initiation and with venous thromboembolism but not with major adverse cardiac events. CONCLUSIONS: Obese patients are more likely to be hospitalized with COVID-19, and are at higher risk of in-hospital death or mechanical ventilation, in particular, if young (age ≤50 years). Obese patients are also at higher risk for venous thromboembolism and dialysis. These observations support clear public health messaging and rigorous adherence to COVID-19 prevention strategies in all obese individuals regardless of age.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 135-144 |
| Number of pages | 10 |
| Journal | Circulation |
| Volume | 143 |
| Issue number | 2 |
| DOIs | |
| State | Published - Jan 12 2021 |
Funding
The American Heart Association’s suite of registries is funded by multiple industry sponsors and its COVID-19 CVD Registry is supported in part by The Gordon and Betty Moore Foundation. Drs Hendren, Das, Rao, Carter, Rosenblatt, Omar, Khera, Hegde, and Drazner as well as C. Ayers and J. Walchok report no relevant conflicts of interest or disclosures. Dr de Lemos has received fees for participating in Data Monitoring Committees from Eli Lilly and Novo Nordisc and consulting income from Jannsen. Dr Neeland has received honoraria, consulting, speaker’s bureau fees, and travel support from Boehringer-Ingelheim/Lilly Alliance (significant), a research grant from Novo Nordisk (significant), and has been a member of a scientific advisory board regarding obesity for AMRA Medical (modest) and Merck (modest). Dr Grodin has received research funding from the Texas Health Resources Clinical Scholarship and consulting fees from Pfizer, Eidos, and Alnylam.
Keywords
- COVID-19
- body mass index
- death
- obesity
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)
