Characteristics and outcomes of 627 044 COVID-19 patients living with and without obesity in the United States, Spain, and the United Kingdom

  1. Martina Recalde
  2. Elena Roel
  3. Andrea Pistillo
  4. Anthony G. Sena
  5. Albert Prats-Uribe
  6. Waheed-Ul-Rahman Ahmed
  7. Heba Alghoul
  8. Thamir M. Alshammari
  9. Osaid Alser
  10. Carlos Areia
  11. Edward Burn
  12. Paula Casajust
  13. Dalia Dawoud
  14. Scott L. DuVall
  15. Thomas Falconer
  16. Sergio Fernández-Bertolín
  17. Asieh Golozar
  18. Mengchun Gong
  19. Lana Yin Hui Lai
  20. Jennifer C. E. Lane
  21. Kristine E. Lynch
  22. Michael E. Matheny
  23. Paras P. Mehta
  24. Daniel R. Morales
  25. Karthik Natarjan
  26. Fredrik Nyberg
  27. Jose D. Posada
  28. Christian G. Reich
  29. Peter R. Rijnbeek
  30. Lisa M. Schilling
  31. Karishma Shah
  32. Nigam H. Shah
  33. Vignesh Subbian
  34. Lin Zhang
  35. Hong Zhu
  36. Patrick Ryan
  37. Daniel Prieto-Alhambra
  38. Kristin Kostka
  39. Talita Duarte-Salles

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Abstract

Background

A detailed characterization of patients with COVID-19 living with obesity has not yet been undertaken. We aimed to describe and compare the demographics, medical conditions, and outcomes of COVID-19 patients living with obesity (PLWO) to those of patients living without obesity.

Methods

We conducted a cohort study based on outpatient/inpatient care and claims data from January to June 2020 from Spain, the UK, and the US. We used six databases standardized to the OMOP common data model. We defined two non-mutually exclusive cohorts of patients diagnosed and/or hospitalized with COVID-19; patients were followed from index date to 30 days or death. We report the frequency of demographics, prior medical conditions, and 30-days outcomes (hospitalization, events, and death) by obesity status.

Results

We included 627 044 (Spain: 122 058, UK: 2336, and US: 502 650) diagnosed and 160 013 (Spain: 18 197, US: 141 816) hospitalized patients with COVID-19. The prevalence of obesity was higher among patients hospitalized (39.9%, 95%CI: 39.8−40.0) than among those diagnosed with COVID-19 (33.1%; 95%CI: 33.0−33.2). In both cohorts, PLWO were more often female. Hospitalized PLWO were younger than patients without obesity. Overall, COVID-19 PLWO were more likely to have prior medical conditions, present with cardiovascular and respiratory events during hospitalization, or require intensive services compared to COVID-19 patients without obesity.

Conclusion

We show that PLWO differ from patients without obesity in a wide range of medical conditions and present with more severe forms of COVID-19, with higher hospitalization rates and intensive services requirements. These findings can help guiding preventive strategies of COVID-19 infection and complications and generating hypotheses for causal inference studies.

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  1. Version published to 10.1038/s41366-021-00893-4
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    SciScore for 10.1101/2020.09.02.20185173: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: All the data partners obtained Institutional Review Board (IRB) approval or exemption to conduct this study.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablecovering New York-Presbyterian Hospital and its affiliated physician practices; IQVIA Open Claims, which are pre-adjudicated claims collected from office based physicians and specialists covering over 300 million lives (~80% of the US population); and the United States Department of Veterans Affairs (VA-OMOP), covering the national Department of Veterans Affairs health care system which serves more than 9 million enrolled Veterans (of whom 93% are male).

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Despite this limitation, our results are in line with previous studies where obesity was associated with an increased risk of hospitalization and mortality, adjusting for sex, age, and comorbidities.7,8,10,13 Given the scarcity of evidence regarding the frequency of specific adverse events during hospitalization among obese patients, our findings are of special interest to the field and should be addressed in upcoming associative studies. Since obesity has been associated with different forms of influenza, an association with COVID-19 was expected from the beginning of the pandemic.34 Interestingly, we found that the prevalence of obesity was higher among both COVID-19 diagnosed and hospitalized patients compared to those with seasonal influenza, which may be suggestive of an inherent vulnerability towards COVID-19 among obese patients. In both COVID-19 and influenza cohorts, female sex was more frequent than male sex. A large study comparing hospitalized patients with COVID-19 to those with influenza found that COVID-19 patients were predominantly male whereas those with influenza were mostly women.35 While our study replicated those findings for non-obese patients, we observed that women predominated among obese patients hospitalized with COVID-19. Thus, our results provide a finer picture of the most frequent sex of patients with COVID-19 among those with obesity. Older age has been associated with an increased risk of more severe forms of both COVID-19 and influenza,3 how...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.09.02.20185173v1 on medRxiv