Body mass index and risk of COVID-19 diagnosis, hospitalisation, and death: a cohort study of 2 524 926 Catalans

Abstract

Context

A comprehensive understanding of the association between body mass index (BMI) and COVID-19 is still lacking.

Objective

To investigate associations between BMI and risk of COVID-19 diagnosis, hospitalisation with COVID-19, and death after a COVID-19 diagnosis or hospitalisation (subsequent death), accounting for potential effect modification by age and sex.

Design

Population-based cohort study.

Setting

Primary care records covering >80% of the Catalan population, linked to region-wide testing, hospital, and mortality records from March to May 2020.

Participants

Adults (≥18 years) with at least one measurement of weight and height.

Main outcome measures

Hazard ratios (HR) for each outcome.

Results

We included 2 524 926 participants. After 67 days of follow-up, 57 443 individuals were diagnosed with COVID-19, 10 862 were hospitalised with COVID-19, and 2467 had a subsequent death. BMI was positively associated with being diagnosed and hospitalised with COVID-19. Compared to a BMI of 22kg/m ², the HR (95%CI) of a BMI of 31kg/m ² was 1.22 (1.19-1.24) for diagnosis, and 1.88 (1.75-2.03) and 2.01 (1.86-2.18) for hospitalisation without and with a prior outpatient diagnosis, respectively. The association between BMI and subsequent death was J-shaped, with a modestly higher risk of death among individuals with BMIs ≤19kg/m ² and a more pronounced increasing risk for BMIs ≥40kg/m ². The increase in risk for COVID-19 outcomes was particularly pronounced among younger patients.

Conclusions

There is a monotonic association between BMI and COVID-19 diagnosis and hospitalisation risks, but a J-shaped one with mortality. More research is needed to unravel the mechanisms underlying these relationships.

Journal

Journal ID (nlm-ta): J Clin Endocrinol Metab

Journal ID (iso-abbrev): J Clin Endocrinol Metab

Journal ID (publisher-id): jcem

Title: The Journal of Clinical Endocrinology and Metabolism

Publisher: Oxford University Press (US )

ISSN (Print): 0021-972X

ISSN (Electronic): 1945-7197

Publication date (Electronic): 23 July 2021

Publication date PMC-release: 23 July 2021

Affiliations

[1 ]Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol) , Barcelona, Spain

[2 ]Universitat Autònoma de Barcelona , Spain

[3 ]International Agency for Research on Cancer (IARC-WHO), 150 Cours Albert Thomas , 69008 Lyon, France

[4 ]Centre for Statistics in Medicine , NDORMS, University of Oxford

[5 ]Department of Medical Informatics, Erasmus University Medical Center , Rotterdam, Netherlands

Author notes

CORRESPONDING AUTHOR: Daniel Prieto-Alhambra, Botnar Research Centre, Windmill Road, OX37LD, Oxford, United Kingdom, daniel.prietoalhambra@ 123456ndorms.ox.ac.uk

CORRESPONDING AUTHOR: Talita Duarte-Salles, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona – Spain, tduarte@ 123456idiapjgol.org

Joint senior authorship

Article

Publisher ID: dgab546

DOI: 10.1210/clinem/dgab546

PMC ID: 8344917

PubMed ID: 34297116

SO-VID: 999628ff-7828-4ee1-bd32-5d018d48d58c

Copyright statement: © The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society.

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

Product

Categories

Subject: Clinical Research Article

Subject: AcademicSubjects/MED00250

Custom metadata

article-lifecycle PAP

edited-state accepted-manuscript