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

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          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.

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          Author and article information

          Journal
          J Clin Endocrinol Metab
          J Clin Endocrinol Metab
          jcem
          The Journal of Clinical Endocrinology and Metabolism
          Oxford University Press (US )
          0021-972X
          1945-7197
          23 July 2021
          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
          dgab546
          10.1210/clinem/dgab546
          8344917
          34297116
          999628ff-7828-4ee1-bd32-5d018d48d58c
          © The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society.

          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
          Clinical Research Article
          AcademicSubjects/MED00250
          Custom metadata
          PAP
          accepted-manuscript

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