Associations between body-mass index and COVID-19 severity in 6·9 million people in England: a prospective, community-based, cohort study.
Associations between body-mass index and COVID-19 severity in 6·9 million people in England: a prospective, community-based, cohort study.
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DOI：
10.1016/s2213-8587(21)00089-9
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发表时间：
2021-06
期刊：
影响因子：
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通讯作者：
Jebb SA
中科院分区：
文献类型：
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作者：
Gao M;Piernas C;Astbury NM;Hippisley-Cox J;O'Rahilly S;Aveyard P;Jebb SA
肥胖是SARS-CoV-2感染后不良结局的主要危险因素。我们的目的是检查这种关联，包括与人口统计学和行为特征，2型糖尿病和其他健康状况的相互作用。在这项前瞻性、基于社区的队列研究中，我们使用了来自英国英格兰QResearch全科医学数据库的去识别患者水平数据。我们提取了20岁及以上患者的数据，这些患者在2020年1月24日（英国首次记录感染的日期）至2020年4月30日期间在有资格纳入QResearch数据库的诊所注册，并提供了BMI数据。提取的数据包括人口统计学、临床、与英格兰公共卫生局SARS-CoV-2阳性检测结果数据库相关的临床值，以及国家统计局的死亡证明。作为严重COVID-19的替代指标，结局为因COVID-19入院、入住重症监护室（ICU）和死亡。我们使用考克斯比例风险模型来估计严重COVID-19的风险，依次调整人口统计学特征、行为因素和合并症。在6 910 695名合格个体（平均BMI 26·78 kg/m2 [SD 5·59]）中，13 503人（0·20%）在SARS-CoV-2检测阳性后入院，1601人（0·02%）进入ICU，5479人（0·08%）死亡。我们发现BMI与因COVID-19入院之间存在J型关联（从BMI 23 kg/m2的最低值调整的风险比[HR]/kg/m2为1.05 [95% CI 1.05 - 1.05]）和死亡（1·04 [1·04-1·05]），在整个BMI范围内与ICU入院呈线性相关（1·10 [1·09-1·10]）。我们发现BMI与年龄和种族之间存在显着的相互作用，对于BMI 23 kg/m2以上的年轻人，HR/kg/m2更高（20-39岁年龄组与80-100岁年龄组中，BMI 23 kg/m2以上入院时的校正HR/kg/m2分别为1·09 [95% CI 1·08-1·10]和1·01 [1·00-1·02]）黑人比白色人多（1·07 [1·06-1·08] vs 1·04 [1·04-1·05]）。2型糖尿病、高血压和心血管疾病患者因COVID-19入院和ICU的风险与BMI单位增加相关，略低于无这些疾病的患者。当BMI超过23 kg/m2时，我们发现严重COVID-19导致入院和死亡的风险呈线性增加，在整个BMI范围内入住ICU的风险呈线性增加，这并不归因于相关疾病的过度风险。BMI增加带来的相对风险在40岁以下的黑人中尤其明显。牛津生物医学研究中心。
Obesity is a major risk factor for adverse outcomes after infection with SARS-CoV-2. We aimed to examine this association, including interactions with demographic and behavioural characteristics, type 2 diabetes, and other health conditions. In this prospective, community-based, cohort study, we used de-identified patient-level data from the QResearch database of general practices in England, UK. We extracted data for patients aged 20 years and older who were registered at a practice eligible for inclusion in the QResearch database between Jan 24, 2020 (date of the first recorded infection in the UK) and April 30, 2020, and with available data on BMI. Data extracted included demographic, clinical, clinical values linked with Public Health England's database of positive SARS-CoV-2 test results, and death certificates from the Office of National Statistics. Outcomes, as a proxy measure of severe COVID-19, were admission to hospital, admission to an intensive care unit (ICU), and death due to COVID-19. We used Cox proportional hazard models to estimate the risk of severe COVID-19, sequentially adjusting for demographic characteristics, behavioural factors, and comorbidities. Among 6 910 695 eligible individuals (mean BMI 26·78 kg/m2 [SD 5·59]), 13 503 (0·20%) were admitted to hospital, 1601 (0·02%) to an ICU, and 5479 (0·08%) died after a positive test for SARS-CoV-2. We found J-shaped associations between BMI and admission to hospital due to COVID-19 (adjusted hazard ratio [HR] per kg/m2 from the nadir at BMI of 23 kg/m2 of 1·05 [95% CI 1·05–1·05]) and death (1·04 [1·04–1·05]), and a linear association across the whole BMI range with ICU admission (1·10 [1·09–1·10]). We found a significant interaction between BMI and age and ethnicity, with higher HR per kg/m2 above BMI 23 kg/m2 for younger people (adjusted HR per kg/m2 above BMI 23 kg/m2 for hospital admission 1·09 [95% CI 1·08–1·10] in 20–39 years age group vs 80–100 years group 1·01 [1·00–1·02]) and Black people than White people (1·07 [1·06–1·08] vs 1·04 [1·04–1·05]). The risk of admission to hospital and ICU due to COVID-19 associated with unit increase in BMI was slightly lower in people with type 2 diabetes, hypertension, and cardiovascular disease than in those without these morbidities. At a BMI of more than 23 kg/m2, we found a linear increase in risk of severe COVID-19 leading to admission to hospital and death, and a linear increase in admission to an ICU across the whole BMI range, which is not attributable to excess risks of related diseases. The relative risk due to increasing BMI is particularly notable people younger than 40 years and of Black ethnicity. NIHR Oxford Biomedical Research Centre.