Body Mass Index and Risk for COVID-19-Related Hospitalization, Intensive Care Unit Admission, Invasive Mechanical Ventilation, and Death - United States, March-December 2020
Lyudmyla Kompaniyets, Alyson B Goodman, Brook Belay, David S Freedman, Marissa S Sucosky, Samantha J Lange, Adi V Gundlapalli, Tegan K Boehmer, Heidi M Blanck, Lyudmyla Kompaniyets, Alyson B Goodman, Brook Belay, David S Freedman, Marissa S Sucosky, Samantha J Lange, Adi V Gundlapalli, Tegan K Boehmer, Heidi M Blanck
Abstract
Obesity* is a recognized risk factor for severe COVID-19 (1,2), possibly related to chronic inflammation that disrupts immune and thrombogenic responses to pathogens (3) as well as to impaired lung function from excess weight (4). Obesity is a common metabolic disease, affecting 42.4% of U.S. adults (5), and is a risk factor for other chronic diseases, including type 2 diabetes, heart disease, and some cancers.† The Advisory Committee on Immunization Practices considers obesity to be a high-risk medical condition for COVID-19 vaccine prioritization (6). Using data from the Premier Healthcare Database Special COVID-19 Release (PHD-SR),§ CDC assessed the association between body mass index (BMI) and risk for severe COVID-19 outcomes (i.e., hospitalization, intensive care unit [ICU] or stepdown unit admission, invasive mechanical ventilation, and death). Among 148,494 adults who received a COVID-19 diagnosis during an emergency department (ED) or inpatient visit at 238 U.S. hospitals during March-December 2020, 28.3% had overweight and 50.8% had obesity. Overweight and obesity were risk factors for invasive mechanical ventilation, and obesity was a risk factor for hospitalization and death, particularly among adults aged <65 years. Risks for hospitalization, ICU admission, and death were lowest among patients with BMIs of 24.2 kg/m2, 25.9 kg/m2, and 23.7 kg/m2, respectively, and then increased sharply with higher BMIs. Risk for invasive mechanical ventilation increased over the full range of BMIs, from 15 kg/m2 to 60 kg/m2. As clinicians develop care plans for COVID-19 patients, they should consider the risk for severe outcomes in patients with higher BMIs, especially for those with severe obesity. These findings highlight the clinical and public health implications of higher BMIs, including the need for intensive COVID-19 illness management as obesity severity increases, promotion of COVID-19 prevention strategies including continued vaccine prioritization (6) and masking, and policies to ensure community access to nutrition and physical activities that promote and support a healthy BMI.
Conflict of interest statement
All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. John House reports employment with Premier, Inc. No other potential conflicts of interest were disclosed.
Figures
References
- Tartof SY, Qian L, Hong V, et al. Obesity and mortality among patients diagnosed with COVID-19: results from an integrated health care organization. Ann Intern Med 2020;173:773–81. 10.7326/M20-3742
- Anderson MR, Geleris J, Anderson DR, et al. Body mass index and risk for intubation or death in SARS-CoV-2 infection: a retrospective cohort study. Ann Intern Med 2020;173:782–90. 10.7326/M20-3214
- Popkin BM, Du S, Green WD, et al. Individuals with obesity and COVID-19: a global perspective on the epidemiology and biological relationships. Obes Rev 2020;21:e13128. 10.1111/obr.13128
- Dixon AE, Peters U. The effect of obesity on lung function. Expert Rev Respir Med 2018;12:755–67. 10.1080/17476348.2018.1506331
- Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief 2020;360:1–8.
- Dooling K, Marin M, Wallace M, et al. The Advisory Committee on Immunization Practices’ updated interim recommendation for allocation of COVID-19 vaccine—United States, December 2020. MMWR Morb Mortal Wkly Rep 2021;69:1657–60. 10.15585/mmwr.mm695152e2
- Wong ES, Wang BC, Garrison LP, et al. Examining the BMI-mortality relationship using fractional polynomials. BMC Med Res Methodol 2011;11:175. 10.1186/1471-2288-11-175
- Guisado-Vasco P, Cano-Megías M, Rodríguez-López M, de-Luna-Boquera IM, Carnevali-Ruiz D; Immunosuppressants Against COVID-19 Working Team. COVID-19 and metabolic syndrome: NF-κB activation. Crossroads. Trends Endocrinol Metab 2020;31:802–3. 10.1016/j.tem.2020.08.004
- Dobner J, Kaser S. Body mass index and the risk of infection—from underweight to obesity. Clin Microbiol Infect 2018;24:24–8. 10.1016/j.cmi.2017.02.013
- Wagenaar CA, Dekker LH, Navis GJ. Prevalence of sarcopenic obesity and sarcopenic overweight in the general population: the lifelines cohort study. Clin Nutr 2021;S0261–5614(21)00012–1.
Source: PubMed