VA Health Services Research and Development Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA.
VA Health Services Research and Development Center for the Study of Health Care Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
Obesity (Silver Spring). 2021 May;29(5):825-828. doi: 10.1002/oby.23121. Epub 2021 Mar 17.
The purpose of this study was to assess associations between BMI and severe coronavirus disease 2019 (COVID-19) outcomes: hospitalization, intensive care unit (ICU) admission, and mortality. A secondary aim was to investigate whether associations varied by age.
The cohort comprised patients in the Veterans Health Administration (VHA) who tested positive for COVID-19 (N = 9,347). For each outcome, we fit piecewise logistic regression models with restricted cubic splines (knots at BMI of 23, 30, and 39), adjusting for age, sex, comorbidities, VHA nursing home residence, and race/ethnicity. Supplemental analyses included age-by-BMI interaction terms (α = 0.05).
We found evidence of a nonlinear J-curve association between BMI and likelihood of hospitalization and mortality. BMI was associated with increased odds for hospitalization, ICU admission, and mortality among patients with BMI 30 to 39 but decreased odds of hospitalization and mortality for patients with BMI 23 to 30. Patients under age 75 with BMI between 30 and 39 had increased odds for mortality with increasing BMI.
Odds for severe outcomes with COVID-19 infection increased with increasing BMI for people with, but not without, obesity. This nonlinear relationship should be tested in future research. COVID-19 public health messages in VHA, and broadly, should incorporate information about risks associated with all classes of obesity, particularly for those under age 75.
本研究旨在评估体重指数（BMI）与严重 2019 年冠状病毒病（COVID-19）结局之间的关联：住院、重症监护病房（ICU）入住和死亡。次要目的是调查这些关联是否因年龄而异。
该队列包括退伍军人健康管理局（VHA）中 COVID-19 检测呈阳性的患者（N=9347）。对于每种结局，我们使用分段逻辑回归模型和限制三次样条（BMI 为 23、30 和 39 处的节点）进行拟合，调整了年龄、性别、合并症、VHA 疗养院居住情况和种族/民族。补充分析包括年龄与 BMI 的交互项（α=0.05）。
我们发现 BMI 与住院和死亡可能性之间存在非线性 J 形关联的证据。BMI 与 BMI 为 30 至 39 的患者的住院、ICU 入住和死亡的几率增加相关，但与 BMI 为 23 至 30 的患者的住院和死亡几率降低相关。年龄在 75 岁以下、BMI 在 30 至 39 之间的患者，BMI 越高，死亡的几率越大。
对于 COVID-19 感染的严重结局，肥胖患者的 BMI 越高，其几率就越大。未来的研究应检验这种非线性关系。VHA 中的 COVID-19 公共卫生信息，以及更广泛地说，应纳入与所有肥胖程度相关的风险信息，特别是对于年龄在 75 岁以下的人。
