Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York

Abstract

Background & aims: New York is the current epicenter of Coronavirus disease 2019 (COVID-19) pandemic. The underrepresented minorities, where the prevalence of obesity is higher, appear to be affected disproportionately. Our objectives were to assess the characteristics and early outcomes of patients hospitalized with COVID-19 in the Bronx and investigate whether obesity is associated with worse outcomes independently from age, gender and other comorbidities. Methods: This retrospective study included the first 200 patients admitted to a tertiary medical center with COVID-19. The electronic medical records were reviewed at least three weeks after admission. The primary endpoint was in-hospital mortality. Results: 200 patients were included (female sex: 102, African American: 102). The median BMI was 30 kg/m 2 . The median age was 64 years. Hypertension (76%), hyperlipidemia (46.2%), and diabetes (39.5%) were the three most common comorbidities. Fever (86%), cough (76.5%), and dyspnea (68%) were the three most common symptoms. 24% died during hospitalization (BMI b 25 kg/m 2 : 31.6%, BMI 25-34 kg/m 2 : 17.2%, BMI ≥ 35 kg/m 2 : 34.8%, p = 0.03). Increasing age (analyzed in quartiles), male sex, BMI ≥ 35 kg/m 2 (reference: BMI 25-34 kg/m 2 ), heart failure, CAD, and CKD or ESRD were found to have a significant univariate association with mortality. The multivariate analysis demonstrated that BMI ≥ 35 kg/m 2 (reference: BMI 25-34 kg/m 2 , OR: 3.78; 95% CI: 1.45-9.83; p = 0.006), male sex (OR: 2.74; 95% CI: 1.25-5.98; p = 0.011) and increasing age (analyzed in quartiles, OR: 1.73; 95% CI: 1.13-2.63; p = 0.011) were independently associated with higher in-hospital mortality. Similarly, age, male sex, BMI ≥ 35 kg/m 2 and current or prior smoking were significant predictors for increasing oxygenation requirements in the multivariate analysis, while male sex, age and BMI ≥ 35 kg/m 2 were significant predictors in the multivariate analysis for the outcome of intubation. Conclusions: In this cohort of hospitalized patients with COVID-19 in a minority-predominant population, severe obesity, increasing age, and male sex were independently associated with higher in-hospital mortality and in general worse in-hospital outcomes.

Azithromycin with nitazoxanide, hydroxychloroquine or ivermectin, with or without dutasteride, for early stage COVID-19: an open-label prospective observational study in males with mild-to-moderate COVID-19 (The Pre-AndroCoV Male Trial).

“…Aging, obesity, uncompensated type 2 diabetes mellitus (T2DM), hypertension, male sex, and presence of male androgenetic alopecia (AGA) have been detected as risk factors for COVID-19 complications (1)(2)(3)(4)(5)(6).…”

The Perfect Storm: COVID-19 Health Disparities in US Blacks

“…Health disparities in the COVID-19 pandemic are glaringly apparent, which is due in part to the increased prevalence of comorbidities affecting minority racial/ethnic groups including Blacks, Hispanics, Native Americans, and Asian Americans [ 1 – 5 ]. To date, greater than 180,000 deaths have occurred in the USA, having the greatest mortality among Non-Hispanic Blacks (NHBs) compared with any other racial group [ 6 ].…”

Commentary: Statins, COVID-19, and coronary artery disease: killing two birds with one stone

“…In addition, underlying cardiovascular diseases (CVDs) and/or cardiovascular risk factors ( e.g. , smoking, diabetes, obesity) have been associated with an increased risk of severe clinical complications and death in COVID-19 patients [ [6] , [7] , [8] , [9] , [10] , [11] , [12] ].…”