Morbid obesity as a risk factor for hospitalization and death due to 2009 pandemic influenza A(H1N1) disease.
Morbid obesity as a risk factor for hospitalization and death due to 2009 pandemic influenza A(H1N1) disease.
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DOI：
10.1371/journal.pone.0009694
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发表时间：
2010-03-15
期刊：
影响因子：
3.7
通讯作者：
Fry AM
中科院分区：
文献类型：
--
作者：
Morgan OW;Bramley A;Fowlkes A;Freedman DS;Taylor TH;Gargiullo P;Belay B;Jain S;Cox C;Kamimoto L;Fiore A;Finelli L;Olsen SJ;Fry AM
据报告，2009年甲型H1N1大流行感染导致肥胖者或病态肥胖者罹患严重疾病。我们评估了肥胖是否是2009年甲型H1N1流感大流行导致住院和死亡的风险因素，独立于免疫做法咨询委员会(ACIP)认为会增加流感相关并发症风险的慢性疾病。我们采用病例队列设计，将2009年4月至7月期间发生的2009年甲型H1N1流感大流行住院和死亡病例与2003-2006年全国健康和营养检查调查(NHANES)估计的美国人口队列进行比较；孕妇和儿童及2岁以下儿童除外。对于住院，我们根据体重指数(BMI，kg/m2)定义了相对体重的类别；对于死亡，肥胖或病态肥胖被记录在医疗表和死亡证明上。每个BMI类别的优势比(OR)被确定；正常体重是参考类别。总体而言，361例住院和233例死亡包括确定BMI类别和是否存在ACIP认可的医疗条件的信息。在≥20岁年龄组中，对于患有≥认可的慢性病(OR = 4.9，95%CI2.4-9.9)和没有ACIP认可的慢性病(OR = 4.7，95%CI1.3-17.2)的个体，住院与病态肥胖(BMI BMI 40)相关。在2-19岁的青少年中，有(OR≤12.5，95%CI 3.4-45.5)和无(OR = 5.5，95%CI 1.3-22.5)慢性病的患者住院与体重不足(BMI = 第5百分位数)相关。在2-19岁的个体中，死亡与BMI类别无关。在年龄为20岁且无≥认可的慢性疾病的个体中，死亡与肥胖(OR = 3.1，95%CI：1.5-6.6)和病态肥胖(OR = 7.6，95%CI 2.1-27.9)有关。我们的发现支持这样的观察，即病态肥胖可能与2009年大流行H1N1感染导致的住院和死亡有关。这些并发症可以通过早期抗病毒治疗和接种疫苗来预防。
Severe illness due to 2009 pandemic A(H1N1) infection has been reported among persons who are obese or morbidly obese. We assessed whether obesity is a risk factor for hospitalization and death due to 2009 pandemic influenza A(H1N1), independent of chronic medical conditions considered by the Advisory Committee on Immunization Practices (ACIP) to increase the risk of influenza-related complications. We used a case-cohort design to compare cases of hospitalizations and deaths from 2009 pandemic A(H1N1) influenza occurring between April–July, 2009, with a cohort of the U.S. population estimated from the 2003–2006 National Health and Nutrition Examination Survey (NHANES); pregnant women and children <2 years old were excluded. For hospitalizations, we defined categories of relative weight by body mass index (BMI, kg/m2); for deaths, obesity or morbid obesity was recorded on medical charts, and death certificates. Odds ratio (OR) of being in each BMI category was determined; normal weight was the reference category. Overall, 361 hospitalizations and 233 deaths included information to determine BMI category and presence of ACIP-recognized medical conditions. Among ≥20 year olds, hospitalization was associated with being morbidly obese (BMI≥40) for individuals with ACIP-recognized chronic conditions (OR = 4.9, 95% CI 2.4–9.9) and without ACIP-recognized chronic conditions (OR = 4.7, 95%CI 1.3–17.2). Among 2–19 year olds, hospitalization was associated with being underweight (BMI≤5th percentile) among those with (OR = 12.5, 95%CI 3.4–45.5) and without (OR = 5.5, 95%CI 1.3–22.5) ACIP-recognized chronic conditions. Death was not associated with BMI category among individuals 2–19 years old. Among individuals aged ≥20 years without ACIP-recognized chronic medical conditions death was associated with obesity (OR = 3.1, 95%CI: 1.5–6.6) and morbid obesity (OR = 7.6, 95%CI 2.1–27.9). Our findings support observations that morbid obesity may be associated with hospitalization and possibly death due to 2009 pandemic H1N1 infection. These complications could be prevented by early antiviral therapy and vaccination.
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