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Abstract
Objectives To investigate the combined association of obesity, diabetes mellitus (DM) and cardiovascular disease (CVD) with severe COVID-19 outcomes in adult and elderly inpatients.
Design Cross-sectional study based on registry data from Brazil’s influenza surveillance system.
Setting Public and private hospitals across Brazil.
Participants Eligible population included 21 942 inpatients aged ≥20 years with positive reverse transcription-PCR test for SARS-CoV-2 until 9 June 2020.
Main outcome measures Severe COVID-19 outcomes were non-invasive and invasive mechanical ventilation use, intensive care unit (ICU) admission and death. Multivariate analyses were conducted separately for adults (20–59 years) and elders (≥60 years) to test the combined association of obesity (without and with DM and/or CVD) and degrees of obesity with each outcome.
Results A sample of 8848 adults and 12 925 elders were included. Among adults, obesity with DM and/or CVD showed higher prevalence of invasive (prevalence ratio 3.76, 95% CI 2.82 to 5.01) and non-invasive mechanical ventilation use (2.06, 1.58 to 2.69), ICU admission (1.60, 1.40 to 1.83) and death (1.79, 1.45 to 2.21) compared with the group without obesity, DM and CVD. In elders, obesity alone (without DM and CVD) had the highest prevalence of ICU admission (1.40, 1.07 to 1.82) and death (1.67, 1.00 to 2.80). In both age groups, obesity alone and combined with DM and/or CVD showed higher prevalence in all outcomes than DM and/or CVD. A dose–response association was observed between obesity and death in adults: class I 1.32 (1.05 to 1.66), class II 1.41 (1.06 to 1.87) and class III 1.77 (1.35 to 2.33).
Conclusions The combined association of obesity, diabetes and/or CVD with severe COVID-19 outcomes may be stronger in adults than in elders. Obesity alone and combined with DM and/or CVD had more impact on the risk of COVID-19 severity than DM and/or CVD in both age groups. The study also supports an independent relationship of obesity with severe outcomes, including a dose–response association between degrees of obesity and death in adults.
- COVID-19
- infectious diseases
- intensive & critical care
- diabetes & endocrinology
- nutrition & dietetics
- epidemiology
Data availability statement
Data are available in a public, open access repository. Data are available upon reasonable request. Data are freely available without restriction at https://opendatasus.saude.gov.br/dataset/bd-srag-2020. Code book and analytical code will be made available upon request from the corresponding author.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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- COVID-19
- infectious diseases
- intensive & critical care
- diabetes & endocrinology
- nutrition & dietetics
- epidemiology
Data availability statement
Data are available in a public, open access repository. Data are available upon reasonable request. Data are freely available without restriction at https://opendatasus.saude.gov.br/dataset/bd-srag-2020. Code book and analytical code will be made available upon request from the corresponding author.
Supplementary materials
Supplementary Data
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Footnotes
Twitter @NJSilvaBR, @MBarreto1954
Contributors NJS, RCRS and RLF designed the study and analysis strategy. NJS, CASTS and MYTI obtained, documented and described the data. AJFF, CSST, ASR, FJOA and IRF carried out the literature search. NJS and EJP performed the data analysis. NJS, RCRS, AJFF, CSST, ASR, FJOA, IRF, ESP and MLB contributed to data interpretation. NJS, AJFF, CSST, ASR, FJO and IRF drafted the manuscript. RCRS, ESP, MYTI and MLB critically revised the manuscript. All authors read and approved the final manuscript.
Funding All authors are affiliated to the Centre for Data and Knowledge Integration for Health (CIDACS) that is funded and supported by MCTI/ NPq/MS/SCTIE/Decit/Bill & Melinda Gates Foundation’s GCE Brazil (OPP1142172), Wellcome Trust (202912/Z/16/Z), the Brazilian Health Surveillance Secretariat, Ministry of Health, Bahia State, Research Support Foundation of the State of Bahia (FAPESB), the Research and Project Funding Agency (FINEP), and the Secretariat of Science and Technology of the State of Bahia (SECTI). ESP is a fellow supported by the Wellcome Trust (213589/Z/18/Z).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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