Obesity and Mortality Among Patients Diagnosed With COVID-19: Results From an Integrated Health Care Organization
Obesity and Mortality Among Patients Diagnosed With COVID-19: Results From an Integrated Health Care Organization
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DOI：
10.7326/m20-3742
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发表时间：
2020-11-17
影响因子：
39.2
通讯作者：
Murali, Sameer B.
中科院分区：
文献类型：
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作者：
Tartof, Sara Y.;Qian, Lei;Murali, Sameer B.
工作背景：肥胖、种族/民族和其他相关特征已成为2019年冠状病毒病的高危因素（COVID-19）相关的结果，但研究尚未充分阐明其影响。目的：确定体重指数（BMI）、相关合并症、时间、社区水平的社会人口学因素，和其他因素对COVID-19死亡风险的影响。设计：回顾性队列研究。设置：Kaiser Permanente Southern加州，一家大型综合医疗保健机构。患者：Kaiser Permanente Southern加州成员，于2020年2月13日至5月2日诊断为COVID-19。测量：多变量泊松回归估计了BMI和其他因素对21天死亡风险的调整效应;模型还按年龄和性别分层。结果：在6916名COVID-19患者中，BMI和死亡风险之间存在J形关联，即使在调整了肥胖相关的合并症之后。与BMI为18.5 - 24 kg/m2的患者相比，BMI为40 - 44 kg/m2和大于45 kg/m2的患者的相对风险分别为2.68（95% CI，1.43 - 5.04）和4.18（CI，2.12 - 8.26）。这种风险在60岁或60岁以下的人和男性中最为显著。未检测到与黑人或拉丁裔种族/民族或其他社会人口学特征相关的死亡风险增加。局限性：可能遗漏了在医疗机构以外发生且未在成员档案中记录的死亡。结论：肥胖在COVID-19死亡风险中起着重要作用，尤其是在男性患者和年轻人群中。我们的资本制度与更平等的医疗保健机会可能解释了种族/民族和社会经济差异对死亡的影响。我们的数据突出了严重肥胖在相关风险因素中的主导作用，为早期干预提供了目标。
Background: Obesity, race/ethnicity, and other correlated characteristics have emerged as high-profile risk factors for adverse coronavirus disease 2019 (COVID-19)-associated outcomes, yet studies have not adequately disentangled their effects.Objective: To determine the adjusted effect of body mass index (BMI), associated comorbidities, time, neighborhood-level sociodemographic factors, and other factors on risk for death due to COVID-19.Design: Retrospective cohort study.Setting: Kaiser Permanente Southern California, a large integrated health care organization.Patients: Kaiser Permanente Southern California members diagnosed with COVID-19 from 13 February to 2 May 2020.Measurements: Multivariable Poisson regression estimated the adjusted effect of BMI and other factors on risk for death at 21 days; models were also stratified by age and sex.Results: Among 6916 patients with COVID-19, there was a J-shaped association between BMI and risk for death, even after adjustment for obesity-related comorbidities. Compared with patients with a BMI of 18.5 to 24 kg/m(2), those with BMIs of 40 to 44 kg/m(2) and greater than 45 kg/m(2) had relative risks of 2.68 (95% CI, 1.43 to 5.04) and 4.18 (CI, 2.12 to 8.26), respectively. This risk was most striking among those aged 60 years or younger and men. Increased risk for death associated with Black or Latino race/ethnicity or other sociodemographic characteristics was not detected.Limitation: Deaths occurring outside a health care setting and not captured in membership files may have been missed.Conclusion: Obesity plays a profound role in risk for death from COVID-19, particularly in male patients and younger populations. Our capitated system with more equalized health care access may explain the absence of effect of racial/ethnic and socioeconomic disparities on death. Our data highlight the leading role of severe obesity over correlated risk factors, providing a target for early intervention.