Body Mass Index and Risk for COVID-19–Related Hospitalization, Intensive Care Unit Admission, Invasive Mechanical Ventilation, and Death — United States, March–December 2020

Abstract

On March 8, 2021, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). Obesity* is a recognized risk factor for severe COVID-19 (1,2), possibly related to chronic inflammation that disrupts immune and thrombogenic responses to pathogens (3) as well as to impaired lung function from excess weight (4). Obesity is a common metabolic disease, affecting 42.4% of U.S. adults (5), and is a risk factor for other chronic diseases, including type 2 diabetes, heart disease, and some cancers. † The Advisory Committee on Immunization Practices considers obesity to be a high-risk medical condition for COVID-19 vaccine prioritization (6). Using data from the Premier Healthcare Database Special COVID-19 Release (PHD-SR), § CDC assessed the association between body mass index (BMI) and risk for severe COVID-19 outcomes (i.e., hospitalization, intensive care unit [ICU] or stepdown unit admission, invasive mechanical ventilation, and death). Among 148,494 adults who received a COVID-19 diagnosis during an emergency department (ED) or inpatient visit at 238 U.S. hospitals during March-December 2020, 28.3% had overweight and 50.8% had obesity. Overweight and obesity were risk factors for invasive mechanical ventilation, and obesity was a risk factor for hospitalization and death, particularly among adults aged <65 years. Risks for hospitalization, ICU admission, and death were lowest among patients with BMIs of 24.2 kg/m 2 , 25.9 kg/m 2 , and 23.7 kg/m 2 , respectively, and then increased sharply with higher BMIs. Risk for invasive mechanical ventilation increased over the full range of BMIs, from 15 kg/m 2 to 60 kg/m 2. As clinicians develop care plans for COVID-19 patients, they should consider the risk for severe outcomes in patients with higher BMIs, especially for those with severe obesity. These findings highlight the clinical and public health implications of higher BMIs, including the need for intensive COVID-19 illness management as obesity severity increases, promotion of COVID-19 prevention strategies including * Obesity (body mass index ≥30 kg/m 2) is frequently categorized into three categories: class 1 (30.0-34.9 kg/m 2), class 2 (35.0-39.9 kg/m 2), and class 3 (≥40 kg/m 2). Class 3 obesity is sometimes referred to as "extreme" or "severe" obesity.

Body mass index and severity/fatality from coronavirus disease 2019: A nationwide epidemiological study in Korea

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“…However, contrary to most recent publications [32], Figure 4b shows that higher BMI decreased the likelihood of being labelled as deceased. Higher BMI being associated with better outcomes has also been reported in veterans [33]. This may be attributed to collider bias, as the number of obese people outnumber the non-obese people in our cohort and obese people are also more likely to be hospitalized for COVID.…”

COVID-19 Tanısı ile Hastanede Yatan Hastalarda Hastanede Kalış Süresini Etkileyen Faktörler Üzerine Bir Araştırma

“…Other analyses of hospital stay time applying the survival analysis techniques can be found in the literature and Factors potentially associated with hospital stay time, e.g, obesity, which may have a nonlinear impact on COVID-19 severity, the prescription of drugs ACEi and/or ARB. [41][42][43][44][45][46] Due to a lack of related information in our dataset, we are unable to compare with these published results.…”