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
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 priv...
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doaj-e89032b989104583bf733de381a5d9fa2021-08-12T07:00:03ZengBMJ Publishing GroupBMJ Open2044-60552021-08-0111810.1136/bmjopen-2021-050739Combined association of obesity and other cardiometabolic diseases with severe COVID-19 outcomes: a nationwide cross-sectional study of 21 773 Brazilian adult and elderly inpatientsMauricio L Barreto0Enny S Paixão1Flávia Jôse Oliveira Alves2Natanael de Jesus Silva3Rita de Cássia Ribeiro-Silva4Andrêa Jacqueline Fortes Ferreira5Camila Silveira Silva Teixeira6Aline Santos Rocha7Ila Rocha Falcão8Elizabete de Jesus Pinto9Carlos Antônio de Souza Teles Santos10Rosemeire Leovigildo Fiaccone11Maria Yury Travassos Ichihara12Rede CoVida, Salvador, BA, BrazilRede CoVida, Salvador, BA, BrazilRede CoVida, Salvador, BA, BrazilRede CoVida, Salvador, BA, BrazilRede CoVida, Salvador, BA, BrazilRede CoVida, Salvador, BA, BrazilRede CoVida, Salvador, BA, BrazilRede CoVida, Salvador, BA, BrazilCentre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, BA, BrazilCentre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, BA, BrazilRede CoVida, Salvador, BA, BrazilRede CoVida, Salvador, BA, BrazilRede CoVida, Salvador, BA, BrazilObjectives 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.https://bmjopen.bmj.com/content/11/8/e050739.full |
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language |
English |
format |
Article |
sources |
DOAJ |
author |
Mauricio L Barreto Enny S Paixão Flávia Jôse Oliveira Alves Natanael de Jesus Silva Rita de Cássia Ribeiro-Silva Andrêa Jacqueline Fortes Ferreira Camila Silveira Silva Teixeira Aline Santos Rocha Ila Rocha Falcão Elizabete de Jesus Pinto Carlos Antônio de Souza Teles Santos Rosemeire Leovigildo Fiaccone Maria Yury Travassos Ichihara |
spellingShingle |
Mauricio L Barreto Enny S Paixão Flávia Jôse Oliveira Alves Natanael de Jesus Silva Rita de Cássia Ribeiro-Silva Andrêa Jacqueline Fortes Ferreira Camila Silveira Silva Teixeira Aline Santos Rocha Ila Rocha Falcão Elizabete de Jesus Pinto Carlos Antônio de Souza Teles Santos Rosemeire Leovigildo Fiaccone Maria Yury Travassos Ichihara 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 BMJ Open |
author_facet |
Mauricio L Barreto Enny S Paixão Flávia Jôse Oliveira Alves Natanael de Jesus Silva Rita de Cássia Ribeiro-Silva Andrêa Jacqueline Fortes Ferreira Camila Silveira Silva Teixeira Aline Santos Rocha Ila Rocha Falcão Elizabete de Jesus Pinto Carlos Antônio de Souza Teles Santos Rosemeire Leovigildo Fiaccone Maria Yury Travassos Ichihara |
author_sort |
Mauricio L Barreto |
title |
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 |
title_short |
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 |
title_full |
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 |
title_fullStr |
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 |
title_full_unstemmed |
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 |
title_sort |
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 |
publisher |
BMJ Publishing Group |
series |
BMJ Open |
issn |
2044-6055 |
publishDate |
2021-08-01 |
description |
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. |
url |
https://bmjopen.bmj.com/content/11/8/e050739.full |
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