Elsevier

Metabolism

Volume 108, July 2020, 154262
Metabolism

COVID-19 in Metabolism
Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York

https://doi.org/10.1016/j.metabol.2020.154262Get rights and content

Highlights

  • Severe obesity, male sex, and increasing age were found to be independently associated with higher in-hospital mortality.

  • Former or current smoking was found to be independently associated to increasing oxygen requirements.

  • Our study population comes from the Bronx, New York, one of the most underserved areas in the United States.

Abstract

Background & aims

New York is the current epicenter of Coronavirus disease 2019 (COVID-19) pandemic. The underrepresented minorities, where the prevalence of obesity is higher, appear to be affected disproportionately. Our objectives were to assess the characteristics and early outcomes of patients hospitalized with COVID-19 in the Bronx and investigate whether obesity is associated with worse outcomes independently from age, gender and other comorbidities.

Methods

This retrospective study included the first 200 patients admitted to a tertiary medical center with COVID-19. The electronic medical records were reviewed at least three weeks after admission. The primary endpoint was in-hospital mortality.

Results

200 patients were included (female sex: 102, African American: 102). The median BMI was 30 kg/m2. The median age was 64 years. Hypertension (76%), hyperlipidemia (46.2%), and diabetes (39.5%) were the three most common comorbidities. Fever (86%), cough (76.5%), and dyspnea (68%) were the three most common symptoms. 24% died during hospitalization (BMI < 25 kg/m2: 31.6%, BMI 25–34 kg/m2: 17.2%, BMI ≥ 35 kg/m2: 34.8%, p = 0.03). Increasing age (analyzed in quartiles), male sex, BMI ≥ 35 kg/m2 (reference: BMI 25–34 kg/m2), heart failure, CAD, and CKD or ESRD were found to have a significant univariate association with mortality. The multivariate analysis demonstrated that BMI ≥ 35 kg/m2 (reference: BMI 25–34 kg/m2, OR: 3.78; 95% CI: 1.45–9.83; p = 0.006), male sex (OR: 2.74; 95% CI: 1.25–5.98; p = 0.011) and increasing age (analyzed in quartiles, OR: 1.73; 95% CI: 1.13–2.63; p = 0.011) were independently associated with higher in-hospital mortality. Similarly, age, male sex, BMI ≥ 35 kg/m2 and current or prior smoking were significant predictors for increasing oxygenation requirements in the multivariate analysis, while male sex, age and BMI ≥ 35 kg/m2 were significant predictors in the multivariate analysis for the outcome of intubation.

Conclusions

In this cohort of hospitalized patients with COVID-19 in a minority-predominant population, severe obesity, increasing age, and male sex were independently associated with higher in-hospital mortality and in general worse in-hospital outcomes.

Abbreviations

COVID-19
Coronavirus disease 2019
SARS-CoV-2
acute respiratory syndrome coronavirus 2
BMI
body mass index
OR
odds ratio
CI
confidence interval
EMR
electronic medical record
SNF
skilled nursing facility

Keywords

COVID-19
SARS-CoV-2
Coronavirus
Obesity
Mortality
Bronx
New York
Pandemic
Risk factor

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