Associations between body-mass index and COVID-19 severity in 6ยท9 million people in England: a prospective, community-based, cohort study.
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BACKGROUND: Obesity is a major risk factor for adverse outcomes after infection with SARS-CoV-2. We aimed to examine this association, including interactions with demographic and behavioural characteristics, type 2 diabetes, and other health conditions. METHODS: In this prospective, community-based, cohort study, we used de-identified patient-level data from the QResearch database of general practices in England, UK. We extracted data for patients aged 20 years and older who were registered at a practice eligible for inclusion in the QResearch database between Jan 24, 2020 (date of the first recorded infection in the UK) and April 30, 2020, and with available data on BMI. Data extracted included demographic, clinical, clinical values linked with Public Health England's database of positive SARS-CoV-2 test results, and death certificates from the Office of National Statistics. Outcomes, as a proxy measure of severe COVID-19, were admission to hospital, admission to an intensive care unit (ICU), and death due to COVID-19. We used Cox proportional hazard models to estimate the risk of severe COVID-19, sequentially adjusting for demographic characteristics, behavioural factors, and comorbidities. FINDINGS: Among 6โ910โ695 eligible individuals (mean BMI 26ยท78 kg/m2 [SD 5ยท59]), 13โ503 (0ยท20%) were admitted to hospital, 1601 (0ยท02%) to an ICU, and 5479 (0ยท08%) died after a positive test for SARS-CoV-2. We found J-shaped associations between BMI and admission to hospital due to COVID-19 (adjusted hazard ratio [HR] per kg/m2 from the nadir at BMI of 23 kg/m2 of 1ยท05 [95% CI 1ยท05-1ยท05]) and death (1ยท04 [1ยท04-1ยท05]), and a linear association across the whole BMI range with ICU admission (1ยท10 [1ยท09-1ยท10]). We found a significant interaction between BMI and age and ethnicity, with higher HR per kg/m2 above BMI 23 kg/m2 for younger people (adjusted HR per kg/m2 above BMI 23 kg/m2 for hospital admission 1ยท09 [95% CI 1ยท08-1ยท10] in 20-39 years age group vs 80-100 years group 1ยท01 [1ยท00-1ยท02]) and Black people than White people (1ยท07 [1ยท06-1ยท08] vs 1ยท04 [1ยท04-1ยท05]). The risk of admission to hospital and ICU due to COVID-19 associated with unit increase in BMI was slightly lower in people with type 2 diabetes, hypertension, and cardiovascular disease than in those without these morbidities. INTERPRETATION: At a BMI of more than 23 kg/m2, we found a linear increase in risk of severe COVID-19 leading to admission to hospital and death, and a linear increase in admission to an ICU across the whole BMI range, which is not attributable to excess risks of related diseases. The relative risk due to increasing BMI is particularly notable people younger than 40 years and of Black ethnicity. FUNDING: NIHR Oxford Biomedical Research Centre.
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2213-8595
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Medical Research Council (MC_UU_12012/1)