Association between cardiometabolic disease and severe COVID-19: a nationwide case-control study of patients requiring invasive mechanical ventilation

Abstract

Aims: The risks associated with diabetes, obesity and hypertension for severe COVID-19 may be confounded and differ by sociodemographic background. We assessed the risks associated with cardiometabolic factors for severe COVID-19 when accounting for socioeconomic factors and in subgroups by age, sex and region of birth.

Methods and results: In this nationwide case-control study, 1.086 patients admitted to intensive care with COVID-19 requiring mechanical ventilation (cases), and 10.860 population-based controls matched for age, sex and district of residency were included from mandatory national registries. ORs with 95% CIs for associations between severe COVID-19 and exposures with adjustment for confounders were estimated using logistic regression. The median age was 62 years (IQR 52-70), and 3003 (24.9%) were women. Type 2 diabetes (OR, 2.3 (95% CI 1.9 to 2.7)), hypertension (OR, 1.7 (95% CI 1.5 to 2.0)), obesity (OR, 3.1 (95% CI 2.4 to 4.0)) and chronic kidney disease (OR, 2.5 (95% CI 1.7 to 3.7)) were all associated with severe COVID-19. In the younger subgroup (below 57 years), ORs were significantly higher for all cardiometabolic risk factors. The risk associated with type 2 diabetes was higher in women (p=0.001) and in patients with a region of birth outside European Union(EU) (p=0.004).

Conclusion: Diabetes, obesity and hypertension were all independently associated with severe COVID-19 with stronger associations in the younger population. Type 2 diabetes implied a greater risk among women and in non-EU immigrants. These findings, originating from high-quality Swedish registries, may be important to direct preventive measures such as vaccination to susceptible patient groups.

Trial registration number: Clinicaltrial.gov (NCT04426084).

Keywords: COVID-19; diabetes & endocrinology; hypertension; intensive & critical care.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

Associations of cardiometabolic risk factors with severe COVID-19 (adjusted ORs with 95% CIs). †Adjusted for age, sex, educational level, marital status and region of birth. ‡Adjusted for age, sex, educational level, marital status, region of birth and all diagnoses in table 3.

Figure 2

Associations of cardiometabolic risk factors with severe COVID-19 by tertiles of age (adjusted ORs with 95% CIs).

Figure 3

Associations of cardiometabolic risk factors with severe COVID-19 by sex (adjusted ORs with 95% CIs). P values denote likelihood-ratio tests between a model with and one without an interaction term between the indicator variable for the subgroup and the risk factor added to model 2.

Figure 4

Associations of cardiometabolic risk factors with severe COVID-19 by region of birth * (adjusted ORs with 95% CIs). *EU 15 comprises of Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden, UK. The Nordic countries include Denmark, Finland, Iceland, Norway and Sweden. P values denote likelihood-ratio tests between a model with and one without an interaction term between the indicator variable for the subgroup and the risk factor added to model 2.