Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA.
VA CT Healthcare System, West Haven, CT, USA.
Int J Epidemiol. 2022 Oct 13;51(5):1371-1383. doi: 10.1093/ije/dyac129.
Due to its large impact on human health, socio-economic status (SES) could at least partially influence the established association between obesity and coronavirus disease 2019 (COVID-19) severity. To estimate the independent effect of body size and SES on the clinical manifestations of COVID-19, we conducted a Mendelian randomization (MR) study.
Applying two-sample MR approaches, we evaluated the effects of body mass index (BMI, n = 322 154), waist circumference (WC, n = 234 069), hip circumference (n = 213 019) and waist-hip ratio (n = 210 088) with respect to three COVID-19 outcomes: severe respiratory COVID-19 (cases = 8779, controls = 1 000 875), hospitalized COVID-19 (cases = 17 992, controls = 1 810 493) and COVID-19 infection (cases = 87 870, controls = 2 210 804). Applying a multivariable MR (MVMR) approach, we estimated the effect of these anthropometric traits on COVID-19 outcomes accounting for the effect of SES assessed as household income (n = 286 301).
BMI and WC were associated with severe respiratory COVID-19 [BMI: odds ratio (OR) = 1.51, CI = 1.24-1.84, P = 3.01e-05; WC: OR = 1.48, 95% CI = 1.15-1.91, P = 0.0019] and hospitalized COVID-19 (BMI: OR = 1.50, 95% CI = 1.32-1.72, P = 8.83e-10; WC: OR = 1.41, 95% CI = 1.20-1.67, P = 3.72e-05). Conversely, income was associated with lower odds of severe respiratory (OR = 0.70, 95% CI = 0.53-0.93, P = 0.015) and hospitalized COVID-19 (OR = 0.78, 95% CI = 0.66-0.92, P = 0.003). MVMR analyses showed that the effect of these obesity-related traits on increasing the odds of COVID-19 negative outcomes becomes null when accounting for income. Conversely, the association of income with lower odds of COVID-19 negative outcomes is not affected when including the anthropometric traits in the multivariable model.
Our findings indicate that SES contributes to the effect of obesity-related traits on COVID-19 severity and hospitalization.
由于肥胖对人类健康有重大影响，社会经济地位（SES）至少可以部分影响肥胖与 2019 年冠状病毒病（COVID-19）严重程度之间的既定关联。为了估计体型和 SES 对 COVID-19 临床症状的独立影响，我们进行了一项孟德尔随机化（MR）研究。
应用两样本 MR 方法，我们评估了体重指数（BMI，n=322154）、腰围（WC，n=234069）、臀围（n=213019）和腰臀比（n=210088）与 COVID-19 三种结局的关系：严重呼吸道 COVID-19（病例=8779，对照=1000875）、住院 COVID-19（病例=17992，对照=1810493）和 COVID-19 感染（病例=87870，对照=2210804）。应用多变量 MR（MVMR）方法，我们估计了这些人体测量特征对 COVID-19 结局的影响，同时考虑了家庭收入（n=286301）评估的 SES 影响。
BMI 和 WC 与严重呼吸道 COVID-19 相关[BMI：比值比（OR）=1.51，95%置信区间（CI）=1.24-1.84，P=3.01e-05；WC：OR=1.48，95%CI=1.15-1.91，P=0.0019]和住院 COVID-19（BMI：OR=1.50，95%CI=1.32-1.72，P=8.83e-10；WC：OR=1.41，95%CI=1.20-1.67，P=3.72e-05）。相反，收入与严重呼吸道（OR=0.70，95%CI=0.53-0.93，P=0.015）和住院 COVID-19（OR=0.78，95%CI=0.66-0.92，P=0.003）的低几率相关。MVMR 分析表明，当考虑收入时，这些与肥胖相关的特征对增加 COVID-19 阴性结果的几率的影响变得无效。相反，当在多变量模型中包含人体测量特征时，收入与 COVID-19 阴性结果几率较低之间的关联不受影响。
我们的研究结果表明，SES 有助于肥胖相关特征对 COVID-19 严重程度和住院的影响。
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