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COMBINED ASSOCIATION OF OBESITY AND OTHER CARDIOMETABOLIC DISEASES 1 WITH SEVERE COVID-19 2 OUTCOMES: A NATIONWIDE CROSS-SECTIONAL STUDY OF 21,773 BRAZILIAN ADULT AND ELDERLY INPATIENTS
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Abstract
Objectives: To investigate the combined association of obesity, diabetes mellitus (DM), and
22 cardiovascular disease (CVD) with severe COVID-19 outcomes in adult and elderly inpatients.
23 Design: Cross-sectional study based on registry data from Brazil’s influenza surveillance system.
24 Setting: Public and private hospitals across Brazil.
25 Participants: Eligible population included 21,942 inpatients aged ≥20 years with positive RT-PCR
26 test for SARS-CoV-2 until Jun 9th, 2020.
27 Main outcome measures: Severe COVID-19 outcomes were non-invasive and invasive mechanical
28 ventilation use, ICU admission, and death.Multivariate analyses were conducted separately for adults
29 (20-59 years) and elders (≥60 years) to test the combined association of obesity (without and with
30 DM and/or CVD) and degrees of obesity with each outcome.
31 Results: A sample of 8,848 adults and 12,925 elders were included. Among adults, obesity with DM
32 and/or CVD showed higher prevalence of invasive (PR 3.76, 95%CI 2.82-5.01) and non-invasive
33 mechanical ventilation use (2.06, 1.58-2.69), ICU admission (1.60, 1.40-1.83), and death (1.79, 1.45-
34 2.21) compared with the group without obesity, DM, and CVD. In elders, obesity alone (without DM
35 and CVD) had the highest prevalence of ICU admission (1.40, 1.07-1.82) and death (1.67, 1.00-2.80).
36 In both age groups, obesity alone and combined with DM and/or CVD showed higher prevalence in
37 all outcomes than DM and/or CVD. A dose-response association was observed between obesity and
38 death in adults: class I 1.32 (1.05-1.66), class II 1.41 (1.06-1.87), and class III 1.77 (1.35-2.33).
39 Conclusions: The combined association of obesity, diabetes, and/or CVD with severe COVID-19
40 outcomes may be stronger in adults than in elders. Obesity alone and combined with DM and/or CVD
41 had more impact on the risk of COVID-19 severity than DM and/or CVD in both age groups. The
42 study also supports an independent relationship of obesity with severe outcomes, including a dose43
response association between degrees of obesity and death in adults.
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