TY - JOUR
T1 - Diabetes and overweight/obesity are independent, nonadditive risk factors for in-hospital severity of covid-19
T2 - An international, multicenter retrospective meta-analysis
AU - Longmore, Danielle K.
AU - Miller, Jessica E.
AU - Bekkering, Siroon
AU - Saner, Christoph
AU - Mifsud, Edin
AU - Zhu, Yanshan
AU - Saffery, Richard
AU - Nichol, Alistair
AU - Colditz, Graham
AU - Short, Kirsty R.
AU - Burgner, David P.
N1 - There was no specific project funding
for the study. Individual investigators were funded
as follows: J.E.M. was supported by a fellowship
from the DHB Foundation, Australia; S.B. is
supported by the Dutch Heart Foundation
(Dekker grant 2018-T028); E.M. is supported by
the World Health Organization Collaborating
Centre for Reference and Research on Influenza, funded by the Australian Commonwealth
Government, Department of Health. K.R.S. was
supported by the Australian Research Council (grant
DE180100512); A.N. is supported by a Health
Research Board of Ireland Clinical Trail Network
award (grant CTN-2014-012); and D.P.B. was
supported by a National Health and Medical
Research Council Australian Investigator grant
(GTN1175744). Research at the Murdoch
Children’s Research Institute is supported
by the Victorian Government’s Operational
Infrastructure Support Program.
The funders had no role in study design, data
collection, data analysis, data interpretation, or
writing of the report.
Publisher Copyright:
© 2021 by the American Diabetes Association.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/6
Y1 - 2021/6
N2 - OBJECTIVE Obesity is an established risk factor for severe coronavirus disease 2019 (COVID-19), but the contribution of overweight and/or diabetes remains unclear. In a multicenter, international study, we investigated if overweight, obesity, and diabetes were independently associated with COVID-19 severity and whether the BMI-associated risk was increased among those with diabetes. RESEARCH DESIGN AND METHODS We retrospectively extracted data from health care records and regional databases of hospitalized adult patients with COVID-19 from 18 sites in 11 countries. We used standardized definitions and analyses to generate site-specific estimates, modeling the odds of each outcome (supplemental oxygen/noninvasive ventilatory support, invasive mechanical ventilatory support, and in-hospital mortality) by BMI category (reference, overweight, obese), adjusting for age, sex, and prespecified comorbidities. Subgroup analysis was performed on patients with preexisting diabetes. Site-specific estimates were combined in a meta-analysis. RESULTS Among 7,244 patients (65.6% overweight/obese), those with overweight were more likely to require oxygen/noninvasive ventilatory support (random effects adjusted odds ratio [aOR] 1.44; 95% CI 1.15–1.80) and invasive mechanical ventilatory support (aOR 1.22; 95% CI 1.03–1.46). There was no association between overweight and in-hospital mortality (aOR 0.88; 95% CI 0.74–1.04). Similar effects were observed in patients with obesity or diabetes. In the subgroup analysis, the aOR for any outcome was not additionally increased in those with diabetes and overweight or obesity. CONCLUSIONS In adults hospitalized with COVID-19, overweight, obesity, and diabetes were associated with increased odds of requiring respiratory support but were not associated with death. In patients with diabetes, the odds of severe COVID-19 were not increased above the BMI-associated risk.
AB - OBJECTIVE Obesity is an established risk factor for severe coronavirus disease 2019 (COVID-19), but the contribution of overweight and/or diabetes remains unclear. In a multicenter, international study, we investigated if overweight, obesity, and diabetes were independently associated with COVID-19 severity and whether the BMI-associated risk was increased among those with diabetes. RESEARCH DESIGN AND METHODS We retrospectively extracted data from health care records and regional databases of hospitalized adult patients with COVID-19 from 18 sites in 11 countries. We used standardized definitions and analyses to generate site-specific estimates, modeling the odds of each outcome (supplemental oxygen/noninvasive ventilatory support, invasive mechanical ventilatory support, and in-hospital mortality) by BMI category (reference, overweight, obese), adjusting for age, sex, and prespecified comorbidities. Subgroup analysis was performed on patients with preexisting diabetes. Site-specific estimates were combined in a meta-analysis. RESULTS Among 7,244 patients (65.6% overweight/obese), those with overweight were more likely to require oxygen/noninvasive ventilatory support (random effects adjusted odds ratio [aOR] 1.44; 95% CI 1.15–1.80) and invasive mechanical ventilatory support (aOR 1.22; 95% CI 1.03–1.46). There was no association between overweight and in-hospital mortality (aOR 0.88; 95% CI 0.74–1.04). Similar effects were observed in patients with obesity or diabetes. In the subgroup analysis, the aOR for any outcome was not additionally increased in those with diabetes and overweight or obesity. CONCLUSIONS In adults hospitalized with COVID-19, overweight, obesity, and diabetes were associated with increased odds of requiring respiratory support but were not associated with death. In patients with diabetes, the odds of severe COVID-19 were not increased above the BMI-associated risk.
UR - http://www.scopus.com/inward/record.url?scp=85111532930&partnerID=8YFLogxK
U2 - 10.2337/dc20-2676
DO - 10.2337/dc20-2676
M3 - Article
C2 - 33858854
AN - SCOPUS:85111532930
VL - 44
SP - 1281
EP - 1290
JO - Diabetes Care
JF - Diabetes Care
SN - 0149-5992
IS - 6
ER -