Family Medicine and Virtual Medicine, Southern California Permanente Medical Group, Huntington Beach, California, USA
Family Medicine, Southern California Permanente Medical Group, Anaheim, California, USA.
BMJ Open. 2022 Jun 29;12(6):e059132. doi: 10.1136/bmjopen-2021-059132.
Obesity has been recognised as a risk factor for poor outcomes associated with COVID-19. Ethnic minorities with COVID-19 have been independently found to fare poorly. We aim to determine if ethnic minorities with severe obesity-defined as a body mass index (BMI) above 40 kg/m²-experience higher rates of hospitalisation, invasive ventilation and death.
Retrospective cohort study from 1 March 2020 to 28 February 2021 within an integrated healthcare organisation in Southern California.
We identified 373 831 patients by COVID-19 diagnosis code or positive laboratory test.
Multivariable Poisson regression with robust error variance estimated adjusted risks of hospitalisation, invasive ventilator use and death within 30 days. Risks were stratified by ethnicity and BMI.
We identified multiple differences in risk of poor outcomes across BMI categories within individual ethnic groups. Hospitalisation risk with a BMI over 45 kg/m² was greater in Asian (RR 2.31, 95% CI 1.53 to 3.49; p<0.001), Hispanic (RR 3.22, 95% CI 2.99 to 3.48; p<0.001) and Pacific Islander (RR 3.79, 95% CI 2.49 to 5.75; p<0.001) patients compared with White (RR 2.04, 95% CI 1.79 to 2.33; p<0.001) and Black (RR 2.00, 95% CI 1.70 to 2.34; p<0.001) patients. A similar trend was observed with invasive ventilation risk. The risk of death was greater in Asian (RR 3.96, 95% CI 1.88 to 8.33; p<0.001), Hispanic (RR 3.03, 95% CI 2.53 to 3.61; p<0.001) and Pacific Islander (RR 4.60, 95% CI 1.42 to 14.92; p=0.011) patients compared with White (RR 1.47, 95% CI 1.13 to 1.91; p=0.005) and Black (RR 2.83, 95% CI 1.99 to 4.02; p<0.001) patients with a BMI over 45 kg/m².
Ethnic minorities with severe obesity, particularly Asian, Hispanic and Pacific Islander patients, had a statistically significant higher risk of hospitalisation, invasive ventilator use and death due to COVID-19. Potential explanations include differences in adipose tissue deposition, overall inflammation and ACE-2 receptor expression.
肥胖已被认为是与 COVID-19 相关不良结局的危险因素。已独立发现 COVID-19 少数民族患者的预后较差。我们旨在确定严重肥胖（BMI 超过 40kg/m²）的少数民族患者的住院、有创通气和死亡的发生率是否更高。
2020 年 3 月 1 日至 2021 年 2 月 28 日，在加利福尼亚州南部的一个综合医疗组织内进行回顾性队列研究。
我们通过 COVID-19 诊断代码或阳性实验室检测确定了 373831 名患者。
使用多变量泊松回归，采用稳健误差方差估计，对 30 天内住院、有创呼吸机使用和死亡的风险进行校正。风险按种族和 BMI 分层。
我们在各个种族群体的 BMI 类别中发现了多种不良结局风险的差异。BMI 超过 45kg/m² 的亚洲人（RR 2.31，95%CI 1.53 至 3.49；p<0.001）、西班牙裔（RR 3.22，95%CI 2.99 至 3.48；p<0.001）和太平洋岛民（RR 3.79，95%CI 2.49 至 5.75；p<0.001）患者的住院风险高于白人（RR 2.04，95%CI 1.79 至 2.33；p<0.001）和黑人（RR 2.00，95%CI 1.70 至 2.34；p<0.001）患者。有创通气风险也存在类似的趋势。BMI 超过 45kg/m² 的亚洲人（RR 3.96，95%CI 1.88 至 8.33；p<0.001）、西班牙裔（RR 3.03，95%CI 2.53 至 3.61；p<0.001）和太平洋岛民（RR 4.60，95%CI 1.42 至 14.92；p=0.011）患者的死亡风险高于白人（RR 1.47，95%CI 1.13 至 1.91；p=0.005）和黑人（RR 2.83，95%CI 1.99 至 4.02；p<0.001）患者。
BMI 超过 45kg/m² 的严重肥胖少数民族患者，特别是亚洲人、西班牙裔和太平洋岛民患者，因 COVID-19 住院、有创通气和死亡的风险显著更高。潜在的解释包括脂肪组织沉积、整体炎症和 ACE-2 受体表达的差异。
