Obesity, chronic disease, age, and in-hospital mortality in patients with covid-19: analysis of ISARIC clinical characterisation protocol UK cohort
Abstract Background Although age, obesity and pre-existing chronic diseases are established risk factors for COVID-19 outcomes, their interactions have not been well researched. Methods We used data from the Clinical Characterisation Protocol UK (CCP-UK) for Severe Emerging Infection developed by th...
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2021-07-01
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Series: | BMC Infectious Diseases |
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Online Access: | https://doi.org/10.1186/s12879-021-06466-0 |
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Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Thomas Yates Francesco Zaccardi Nazrul Islam Cameron Razieh Clare L. Gillies Claire A. Lawson Yogini Chudasama Alex Rowlands Melanie J. Davies Annemarie B. Docherty Peter J. M. Openshaw J. Kenneth Baillie Malcolm G. Semple Kamlesh Khunti |
spellingShingle |
Thomas Yates Francesco Zaccardi Nazrul Islam Cameron Razieh Clare L. Gillies Claire A. Lawson Yogini Chudasama Alex Rowlands Melanie J. Davies Annemarie B. Docherty Peter J. M. Openshaw J. Kenneth Baillie Malcolm G. Semple Kamlesh Khunti Obesity, chronic disease, age, and in-hospital mortality in patients with covid-19: analysis of ISARIC clinical characterisation protocol UK cohort BMC Infectious Diseases Obesity Chronic disease Ageing COVID-19 |
author_facet |
Thomas Yates Francesco Zaccardi Nazrul Islam Cameron Razieh Clare L. Gillies Claire A. Lawson Yogini Chudasama Alex Rowlands Melanie J. Davies Annemarie B. Docherty Peter J. M. Openshaw J. Kenneth Baillie Malcolm G. Semple Kamlesh Khunti |
author_sort |
Thomas Yates |
title |
Obesity, chronic disease, age, and in-hospital mortality in patients with covid-19: analysis of ISARIC clinical characterisation protocol UK cohort |
title_short |
Obesity, chronic disease, age, and in-hospital mortality in patients with covid-19: analysis of ISARIC clinical characterisation protocol UK cohort |
title_full |
Obesity, chronic disease, age, and in-hospital mortality in patients with covid-19: analysis of ISARIC clinical characterisation protocol UK cohort |
title_fullStr |
Obesity, chronic disease, age, and in-hospital mortality in patients with covid-19: analysis of ISARIC clinical characterisation protocol UK cohort |
title_full_unstemmed |
Obesity, chronic disease, age, and in-hospital mortality in patients with covid-19: analysis of ISARIC clinical characterisation protocol UK cohort |
title_sort |
obesity, chronic disease, age, and in-hospital mortality in patients with covid-19: analysis of isaric clinical characterisation protocol uk cohort |
publisher |
BMC |
series |
BMC Infectious Diseases |
issn |
1471-2334 |
publishDate |
2021-07-01 |
description |
Abstract Background Although age, obesity and pre-existing chronic diseases are established risk factors for COVID-19 outcomes, their interactions have not been well researched. Methods We used data from the Clinical Characterisation Protocol UK (CCP-UK) for Severe Emerging Infection developed by the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC). Patients admitted to hospital with COVID-19 from 6th February to 12th October 2020 were included where there was a coded outcome following hospital admission. Obesity was determined by an assessment from a clinician and chronic disease by medical records. Chronic diseases included: chronic cardiac disease, hypertension, chronic kidney disease, chronic pulmonary disease, diabetes and cancer. Mutually exclusive categories of obesity, with or without chronic disease, were created. Associations with in-hospital mortality were examined across sex and age categories. Results The analysis included 27,624 women with 6407 (23.2%) in-hospital deaths and 35,065 men with 10,001 (28.5%) in-hospital deaths. The prevalence of chronic disease in women and men was 66.3 and 68.5%, respectively, while that of obesity was 12.9 and 11.1%, respectively. Association of obesity and chronic disease status varied by age (p < 0.001). Under 50 years of age, obesity and chronic disease were associated with in-hospital mortality within 28 days of admission in a dose-response manner, such that patients with both obesity and chronic disease had the highest risk with a hazard ratio (HR) of in-hospital mortality of 2.99 (95% CI: 2.12, 4.21) in men and 2.16 (1.42, 3.26) in women compared to patients without obesity or chronic disease. Between the ages of 50–69 years, obesity and chronic disease remained associated with in-hospital COVID-19 mortality, but survival in those with obesity was similar to those with and without prevalent chronic disease. Beyond the age of 70 years in men and 80 years in women there was no meaningful difference between those with and without obesity and/or chronic disease. Conclusion Obesity and chronic disease are important risk factors for in-hospital mortality in younger age groups, with the combination of chronic disease and obesity being particularly important in those under 50 years of age. These findings have implications for targeted public health interventions, vaccination strategies and in-hospital clinical decision making. |
topic |
Obesity Chronic disease Ageing COVID-19 |
url |
https://doi.org/10.1186/s12879-021-06466-0 |
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doaj-27a311d3a10849ceb86651e79ecc07302021-08-01T11:47:15ZengBMCBMC Infectious Diseases1471-23342021-07-012111910.1186/s12879-021-06466-0Obesity, chronic disease, age, and in-hospital mortality in patients with covid-19: analysis of ISARIC clinical characterisation protocol UK cohortThomas Yates0Francesco Zaccardi1Nazrul Islam2Cameron Razieh3Clare L. Gillies4Claire A. Lawson5Yogini Chudasama6Alex Rowlands7Melanie J. Davies8Annemarie B. Docherty9Peter J. M. Openshaw10J. Kenneth Baillie11Malcolm G. Semple12Kamlesh Khunti13Diabetes Research Centre, Leicester General Hospital, University of LeicesterDiabetes Research Centre, Leicester General Hospital, University of LeicesterClinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of OxfordDiabetes Research Centre, Leicester General Hospital, University of LeicesterDiabetes Research Centre, Leicester General Hospital, University of LeicesterDiabetes Research Centre, Leicester General Hospital, University of LeicesterLeicester Real World Evidence Unit, Diabetes Research Centre, University of LeicesterDiabetes Research Centre, Leicester General Hospital, University of LeicesterDiabetes Research Centre, Leicester General Hospital, University of LeicesterCentre for Medical Informatics, Usher Institute, University of EdinburghNational Heart and Lung Institute, Imperial College LondonRoslin Institute, University of EdinburghNIHR Health Protection Research Unit in Emerging and Zoonotic Infections and Institute of Translational Medicine, Faculty of Health and Life Sciences, University of LiverpoolDiabetes Research Centre, Leicester General Hospital, University of LeicesterAbstract Background Although age, obesity and pre-existing chronic diseases are established risk factors for COVID-19 outcomes, their interactions have not been well researched. Methods We used data from the Clinical Characterisation Protocol UK (CCP-UK) for Severe Emerging Infection developed by the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC). Patients admitted to hospital with COVID-19 from 6th February to 12th October 2020 were included where there was a coded outcome following hospital admission. Obesity was determined by an assessment from a clinician and chronic disease by medical records. Chronic diseases included: chronic cardiac disease, hypertension, chronic kidney disease, chronic pulmonary disease, diabetes and cancer. Mutually exclusive categories of obesity, with or without chronic disease, were created. Associations with in-hospital mortality were examined across sex and age categories. Results The analysis included 27,624 women with 6407 (23.2%) in-hospital deaths and 35,065 men with 10,001 (28.5%) in-hospital deaths. The prevalence of chronic disease in women and men was 66.3 and 68.5%, respectively, while that of obesity was 12.9 and 11.1%, respectively. Association of obesity and chronic disease status varied by age (p < 0.001). Under 50 years of age, obesity and chronic disease were associated with in-hospital mortality within 28 days of admission in a dose-response manner, such that patients with both obesity and chronic disease had the highest risk with a hazard ratio (HR) of in-hospital mortality of 2.99 (95% CI: 2.12, 4.21) in men and 2.16 (1.42, 3.26) in women compared to patients without obesity or chronic disease. Between the ages of 50–69 years, obesity and chronic disease remained associated with in-hospital COVID-19 mortality, but survival in those with obesity was similar to those with and without prevalent chronic disease. Beyond the age of 70 years in men and 80 years in women there was no meaningful difference between those with and without obesity and/or chronic disease. Conclusion Obesity and chronic disease are important risk factors for in-hospital mortality in younger age groups, with the combination of chronic disease and obesity being particularly important in those under 50 years of age. These findings have implications for targeted public health interventions, vaccination strategies and in-hospital clinical decision making.https://doi.org/10.1186/s12879-021-06466-0ObesityChronic diseaseAgeingCOVID-19 |