Rede CoVida, Salvador, BA, Brazil
Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, BA, Brazil.
BMJ Open. 2021 Aug 9;11(8):e050739. doi: 10.1136/bmjopen-2021-050739.
To investigate the combined association of obesity, diabetes mellitus (DM) and cardiovascular disease (CVD) with severe COVID-19 outcomes in adult and elderly inpatients.
Cross-sectional study based on registry data from Brazil's influenza surveillance system.
Public and private hospitals across Brazil.
Eligible population included 21 942 inpatients aged ≥20 years with positive reverse transcription-PCR test for SARS-CoV-2 until 9 June 2020.
Severe COVID-19 outcomes were non-invasive and invasive mechanical ventilation use, intensive care unit (ICU) admission and death. Multivariate analyses were conducted separately for adults (20-59 years) and elders (≥60 years) to test the combined association of obesity (without and with DM and/or CVD) and degrees of obesity with each outcome.
A sample of 8848 adults and 12 925 elders were included. Among adults, obesity with DM and/or CVD showed higher prevalence of invasive (prevalence ratio 3.76, 95% CI 2.82 to 5.01) and non-invasive mechanical ventilation use (2.06, 1.58 to 2.69), ICU admission (1.60, 1.40 to 1.83) and death (1.79, 1.45 to 2.21) compared with the group without obesity, DM and CVD. In elders, obesity alone (without DM and CVD) had the highest prevalence of ICU admission (1.40, 1.07 to 1.82) and death (1.67, 1.00 to 2.80). In both age groups, obesity alone and combined with DM and/or CVD showed higher prevalence in all outcomes than DM and/or CVD. A dose-response association was observed between obesity and death in adults: class I 1.32 (1.05 to 1.66), class II 1.41 (1.06 to 1.87) and class III 1.77 (1.35 to 2.33).
The combined association of obesity, diabetes and/or CVD with severe COVID-19 outcomes may be stronger in adults than in elders. Obesity alone and combined with DM and/or CVD had more impact on the risk of COVID-19 severity than DM and/or CVD in both age groups. The study also supports an independent relationship of obesity with severe outcomes, including a dose-response association between degrees of obesity and death in adults.
调查肥胖、糖尿病（DM）和心血管疾病（CVD）合并与成人和老年住院患者 COVID-19 重症结局的相关性。
基于巴西流感监测系统的登记数据进行的横断面研究。
巴西各地的公立和私立医院。
符合条件的人群包括 2020 年 6 月 9 日前 21942 名 20 岁及以上、SARS-CoV-2 逆转录-聚合酶链反应检测阳性的住院患者。
COVID-19 重症结局为无创和有创机械通气使用、重症监护病房（ICU）入住和死亡。对成人（20-59 岁）和老年人（≥60 岁）分别进行多变量分析，以检验肥胖（无 DM 和/或 CVD 以及有 DM 和/或 CVD）和肥胖程度与每种结局的联合相关性。
纳入 8848 名成人和 12925 名老年人样本。在成年人中，肥胖伴 DM 和/或 CVD 的有创机械通气使用率（患病率比 3.76，95%置信区间 2.82 至 5.01）和无创机械通气使用率（2.06，1.58 至 2.69）、ICU 入住率（1.60，1.40 至 1.83）和死亡率（1.79，1.45 至 2.21）均高于无肥胖、DM 和 CVD 的人群。在老年人中，单纯肥胖（无 DM 和 CVD）的 ICU 入住率（1.40，1.07 至 1.82）和死亡率（1.67，1.00 至 2.80）最高。在两个年龄组中，肥胖伴 DM 和/或 CVD 以及单纯肥胖的所有结局发生率均高于 DM 和/或 CVD。在成年人中，肥胖与死亡率之间存在剂量-反应关系：I 级 1.32（1.05 至 1.66）、II 级 1.41（1.06 至 1.87）和 III 级 1.77（1.35 至 2.33）。
肥胖、糖尿病和/或 CVD 合并与 COVID-19 重症结局的相关性在成年人中可能强于老年人。单纯肥胖以及肥胖伴 DM 和/或 CVD 比 DM 和/或 CVD 对两个年龄组 COVID-19 严重程度的风险影响更大。该研究还支持肥胖与重症结局之间存在独立关系，包括成年人中肥胖程度与死亡率之间的剂量-反应关系。
