Combined association of obesity and other cardiometabolic diseases with severe COVID-19 outcomes: a nationwide cross-sectional study of 21 773 Brazilian adult and elderly inpatients

  1. Natanael de Jesus Silva
  2. Rita de Cássia Ribeiro-Silva
  3. Andrêa Jacqueline Fortes Ferreira
  4. Camila Silveira Silva Teixeira
  5. Aline Santos Rocha
  6. Flávia Jôse Oliveira Alves
  7. Ila Rocha Falcão
  8. Elizabete de Jesus Pinto
  9. Carlos Antônio de Souza Teles Santos
  10. Rosemeire Leovigildo Fiaccone
  11. Maria Yury Travassos Ichihara
  12. Enny S Paixão
  13. Mauricio L Barreto

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Abstract

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.

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  1. Version published to 10.1136/bmjopen-2021-050739
  2. ScreenIT

    SciScore for 10.1101/2021.05.14.21257204: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: As the study exclusively used publicly available de-identified data, ethics approval by a research ethics committee and informed consent are waived per Resolution n.
    Consent: As the study exclusively used publicly available de-identified data, ethics approval by a research ethics committee and informed consent are waived per Resolution n.
    Sex as a biological variableSex was obtained as a dichotomous variable (female/ male).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: One of the greatest strengths of the study was the use of SIVEP-Gripe dataset. Because severe acute respiratory syndrome is a condition of compulsory notification in both public and private hospitals,31 we have a nationwide representative sample of patients hospitalized for severe COVID-19 in Brazil. In addition, the large sample sizes allowed us to analyze adults and elders separately, as well as the degrees of obesity which dose-response association with death was evidenced. The availability of important confounding variables (sex, age, and preexisting comorbidities) to control the estimated associations, as well as hospital outcomes and mortality of COVID-19, was another differential of the study. Only patients with positive RT-PCR test for SARS-CoV-2 and final diagnosis for COVID-19 were included which gives greater precision on the studied population. The availability and use of data from health surveillance systems may be a lesson from Brazil that other countries can learn for obtaining routine and timely data to guide health systems and research in preparing and responding to pandemics before and during their course. The study also has some limitations that must be considered. Because this is a cross-sectional study, a causal association cannot be inferred. As we used routinely collected data, which has not been designed primarily for research purposes, it may bring well-known limitations related to missing, underestimation, and potential mis...

    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.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.05.14.21257204v1 on medRxiv