Background Obesity is an epidemic in New York City, the global epicenter of the coronavirus pandemic. Previous studies suggest that obesity is a possible risk factor for adverse outcomes in COVID-19. Objective To elucidate the association between obesity and COVID-19 outcomes. Design Retrospective cohort study of COVID-19 hospitalized patients tested between March 10 and April 13, 2020. Setting SUNY Downstate Health Sciences University, a COVID-only hospital in New York. Participants In total, 684 patients were tested for COVID-19 and 504 were analyzed. Patients were categorized into three groups by BMI: normal (BMI 18.50–24.99), overweight (BMI 25.00–29.99), and obese (BMI ≥ 30.00). Measurements Primary outcome was 30-day in-hospital mortality, and secondary outcomes were intubation, acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), and acute cardiac injury (ACI). Results There were 139 patients (27%) with normal BMI, 150 patients who were overweight (30%), and 215 patients with obesity (43%). After controlling for age, gender, diabetes, hypertension, and qSOFA score, there was a significantly increased risk of mortality in the overweight (RR 1.4, 95% CI 1.1–1.9) and obese groups (RR 1.3, 95% CI 1.0–1.7) compared with those with normal BMI. Similarly, there was a significantly increased relative risk for intubation in the overweight (RR 2.0, 95% CI 1.2–3.3) and obese groups (RR 2.4, 95% CI 1.5–4.0) compared with those with normal BMI. Obesity did not affect rates of AKI, ACI, or ARDS. Furthermore, obesity appears to significantly increase the risk of mortality in males (RR 1.4, 95% CI 1.0-2.0, P = 0.03), but not in females (RR 1.2, 95% CI 0.77–1.9, P = 0.40). Conclusion This study reveals that patients with overweight and obesity who have COVID-19 are at increased risk for mortality and intubation compared to those with normal BMI. These findings support the hypothesis that obesity is a risk factor for COVID-19 complications and should be a consideration in management of COVID-19.
Background Maternal smoking during pregnancy is associated with adverse offspring health outcomes across their life course. We hypothesize that DNA methylation is a potential mediator of this relationship. Methods We examined the association of prenatal maternal smoking with offspring blood DNA methylation in 2821 individuals (age 16 to 48 years) from five prospective birth cohort studies and perform Mendelian randomization and mediation analyses to assess whether methylation markers have causal effects on disease outcomes in the offspring. Results We identify 69 differentially methylated CpGs in 36 genomic regions ( P value < 1 × 10 −7 ) associated with exposure to maternal smoking in adolescents and adults. Mendelian randomization analyses provided evidence for a causal role of four maternal smoking-related CpG sites on an increased risk of inflammatory bowel disease or schizophrenia. Further mediation analyses showed some evidence of cg25189904 in GNG12 gene mediating the effect of exposure to maternal smoking on schizophrenia-related outcomes. Conclusions DNA methylation may represent a biological mechanism through which maternal smoking is associated with increased risk of psychiatric morbidity in the exposed offspring. Electronic supplementary material The online version of this article (10.1186/s13148-019-0683-4) contains supplementary material, which is available to authorized users.
Importance: Initial guidelines recommended prompt endotracheal intubation rather than non-invasive ventilation (NIV) for COVID-19 patients requiring ventilator support. There is insufficient data comparing the impact of intubation versus NIV on patient-centered outcomes of these patients. Objective: To compare all-cause 30-day mortality for hospitalized COVID-19 patients with respiratory failure who underwent intubation first, intubation after NIV, or NIV only. Design: Retrospective study of patients admitted in March and April of 2020. Setting: A teaching hospital in Brooklyn, New York City. Participants: Adult COVID-19 confirmed patients who required ventilator support (non-invasive ventilation and/ or endotracheal intubation) at discretion of treating physician, were included. Exposures: Patients were categorized into three exposure groups: intubation-first, intubation after NIV, or NIV-only. Primary outcome: 30-day all-cause mortality, a predetermined outcome measured by multivariable logistic regression. Data are presented with medians and interquartile ranges, or percentages with 95% confidence intervals, for continuous and categorical variables, respectively. Covariates for the model were age, sex, qSOFA score ≥ 2, presenting oxygen saturation, vasopressor use, and greater than three comorbidities. A secondary multivariable model compared mortality of all patients that received NIV (intubation after NIV and NIV-only) with the intubation-first group. Results: A total of 222 were enrolled. Overall mortality was 77.5% (95%CI, 72-83%). Mortality for intubation-first group was 82% (95%CI, 73-89%; 75/91), for Intubation after NIV was 84% (95%CI, 70-92%; 37/44), and for NIVonly was 69% (95%CI, 59-78%; 60/87). In multivariable analysis, NIV-only was associated with decreased all-cause mortality (odds ratio [OR]: 0.30, 95%CI, 0.13-0.69). No difference in mortality was observed between intubationfirst and intubation after NIV. Secondary analysis found all patients who received NIV to have lower mortality than patients who were intubated only (OR: 0.44, 95%CI, 0.21-0.95). Conclusions & Relevance: Utilization of NIV as the initial intervention in COVID-19 patients requiring ventilatory support is associated with significant survival benefit. For patients intubated after NIV, the mortality rate is not worse than those who undergo intubation as their initial intervention.
ObjectivesTo assess socioeconomic inequalities in traumatic dental injuries (TDIs) in adolescents in New Delhi and examine the role of material, psychosocial and behavioural factors in explaining these inequalities.MethodsWe conducted a cross sectional study of 1386 adolescents aged between 12–15 years residing in three diverse areas of New Delhi. A non-invasive clinical examination was used to estimate the prevalence of TDIs, and an interviewer-administered questionnaire was used to gather relevant behavioural and socio-demographic data. Multiple logistic regression models were used to assess the association between area based socioeconomic position and TDIs.ResultsThe overall prevalence of TDIs was 10.9%. Social inequalities in the prevalence of TDIs were observed across the adolescent population according to their area of residence. Socio-economic group differences in the prevalence of TDIs remained statistically significant after adjusting for demographic factors, material resources, social capital, social support and health affecting behaviours (OR 3.36, 95% CI 1.75–6.46 and OR 3.99, 95% CI 1.86–8.56 for adolescents from resettlement areas and urban slums respectively in comparison to middle class adolescents). Different psychosocial, material and socio-demographic variables did not attenuate the estimates for the relationship between area socioeconomic position and TDIs.ConclusionArea of residence was a strong predictor of TDIs in adolescents with a higher prevalence in more deprived areas. Social inequalities in TDIs were not explained by psychosocial and behavioural variables. Health promoting policies aimed at improving the physical environment in which adolescents reside might be instrumental in reducing the prevalence of TDIs and associated inequalities.
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