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 - Funding Information:
Acknowledgments. Authors from several sites wish to extend acknowledgments: Those at Aux-ilogico, Milan, Italy, acknowledge Drs. Irene Campi, Iacopo Chiodini, Luca Giovanelli, Giovanni Perego, Francesca Heilbron, Roberto Menè, Andrea Cas-cella, Stefano Vicini, and all nurses; those at the University of California, Los Angeles, acknowledge Dr. Paul C. Adamson; those in Cape Town, South Africa, acknowledge doctors and nurses working in COVID-19 inpatient service; those in Indonesia thank the patients, doctors, nurses, pharmacists, other health care workers, and research administrators at all the participating sites. Authors in Ticino,Switzerland,acknowledgeLorenzoRuinelli; thoseinLausanne,Switzerland,acknowledgeOriol Manuel, Desgranges Florian, Filippidis Paraskevas, Kampouri Eleftheria-Evdokia, Tschopp Jonathan, and Viala Benjamin; those at Amphia, the Netherlands,acknowledgeA.G.Loman and B.W.Driessen; those at Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands, acknowledge Dr. Bianca M. Boxma-de Klerk; those at Washington University, St. Louis, Missouri, acknowledge Drs. Albert Lai and Randi Foraker of the Institute for Informatics at Washington University School of Medicine. The main writing group acknowledges patients and their families and health care providers worldwide. Funding. There was no specific project funding forthestudy.Individualinvestigatorswerefunded 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 supportedbytheAustralianResearchCouncil(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.
Funding Information:
There was no specific project funding for the study.Individualinvestigators 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 bythe 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.
PY - 2021
Y1 - 2021
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 BMIassociated 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. Sitespecific 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 BMIassociated 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. Sitespecific 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
SN - 0149-5992
VL - 44
SP - 1281
EP - 1290
JO - Diabetes care
JF - Diabetes care
IS - 6
ER -