Analysis of Mortality and Morbidity in COVID-19 Patients with Obesity Using Clinical Epidemiological Data from the Korean Center for Disease Control & Prevention

Abstract

Previous studies have reported the association of obesity with increased morbidity or mortality due to the coronavirus disease 2019 (COVID-19). This study aims to investigate the relationship of obesity, as defined by the body mass index (BMI), with morbidity and mortality due to COVID-19. Data from 5628 confirmed COVID-19 patients were collected by the Centers for Disease Control and Prevention of Korea. The hazard ratios (HRs) for mortality in the BMI groups were analyzed using the Cox proportional hazard model adjusted for covariates. The odds ratios (ORs) of morbidity and diabetes in the BMI groups were analyzed using logistic regression adjusted for the same covariates. Both underweight and obesity were associated with a higher HR for mortality (adjusted HR = 2.28, 95% confidence intervals [95% CI] = 1.23–4.25, p = 0.009 for underweight and adjusted HR = 1.71, 95% CI = 1.10–2.66, p = 0.017 for obese). Obesity was related to higher odds of morbidity (adjusted OR = 1.71, 95% CI = 1.32–2.21, p < 0.001). Underweight and obesity were associated with high mortality and/or morbidity due to COVID-19 in Korea.

The effect of BMI on COVID-19 outcomes among older patients in South Korea: a nationwide retrospective cohort study*

“…High morbidity was defined as the administration of oxygen via nasal cannula or facial mask, non-invasive ventilation, invasive ventilation, multiorgan failure/ECMO, and death. The result of overweight showed no significance, which is also different from the results of our study [ 26 ].…”

“…Underweight patients were not investigated in either study. A recent cohort study conducted in South Korea and published in December 2020 emphasized the increased mortality of underweight patients [ 26 ]. However, the study was designed to include patients under the age of 20 years, and such patients cannot be classified according to adult BMI criteria.…”

Hospitalization, mechanical ventilation, and case-fatality outcomes in US veterans with COVID-19 disease between years 2020–2021

“…The authors reasoned that the underweight groups might have deferred MV on the basis of goals of care discussion [40] . A Korean study also found higher mortality risks (crude hazard ratio=2.56) in the underweight cohort [41] . A US study across 800 hospitals of COVID-19 outcomes in 2020 found higher hospitalization but not ICU admission, MV, or death risks in the underweight cohort [17] .…”

Quality of life and eating habits of patients with obesity during the COVID-19 pandemic

“…This comorbidity profile, commonly seen in obese patients, confers a greater risk of complications when there is a diagnosis of COVID-19. It is estimated that the state of chronic inflammation and the dysregulated immune response increase the chances of these patients presenting severe forms of the disease and dying ( 26 ) .…”