Body Mass Index and Risk for COVID-19-Related Hospitalization, Intensive Care Unit Admission, Invasive Mechanical Ventilation, and Death - United States, March-December 2020

• Published in: MMWR. Morbidity and mortality weekly report Vol. 70; no. 10; pp. 355 - 361
• Main Authors: Kompaniyets, Lyudmyla, Goodman, Alyson B, Belay, Brook, Freedman, David S, Sucosky, Marissa S, Lange, Samantha J, Gundlapalli, Adi V, Boehmer, Tegan K, Blanck, Heidi M
• Format: Journal Article Newsletter
• Language: English
• Published: United States U.S. Government Printing Office 12.03.2021; U.S. Center for Disease Control; Centers for Disease Control and Prevention
• Subjects: Adolescent; Adult; Adults; Age; Aged; Aged, 80 and over; Body mass; Body Mass Index; Body size; Body weight; Chronic diseases; Coronaviruses; COVID-19; COVID-19 - mortality; COVID-19 - therapy; COVID-19 vaccines; Disease prevention; Female; Full Report; Health care; Heart diseases; Hospitalization; Hospitalization - statistics & numerical data; Hospitals; Humans; Illnesses; Intensive care; Intensive Care Units - statistics & numerical data; Lung diseases; Male; Mechanical properties; Mechanical ventilation; Middle Aged; Obesity; Obesity - epidemiology; Overweight; Patients; Public health; Respiration, Artificial - statistics & numerical data; Risk analysis; Risk Assessment; Risk Factors; Sensitivity analysis; Severity of Illness Index; Type 2 diabetes; United States - epidemiology; Vaccines; Ventilation; Ventilators; Young Adult; United States; United States > US
• ISSN: 0149-2195; 1545-861X
• DOI: 10.15585/mmwr.mm7010e4

Obesity* is a recognized risk factor for severe COVID-19 (1,2), possibly related to chronic inflammation that disrupts immune and thrombogenic responses to pathogens (3) as well as to impaired lung function from excess weight (4). Obesity is a common metabolic disease, affecting 42.4% of U.S. adults (5), and is a risk factor for other chronic diseases, including type 2 diabetes, heart disease, and some cancers. The Advisory Committee on Immunization Practices considers obesity to be a high-risk medical condition for COVID-19 vaccine prioritization (6). Using data from the Premier Healthcare Database Special COVID-19 Release (PHD-SR), CDC assessed the association between body mass index (BMI) and risk for severe COVID-19 outcomes (i.e., hospitalization, intensive care unit [ICU] or stepdown unit admission, invasive mechanical ventilation, and death). Among 148,494 adults who received a COVID-19 diagnosis during an emergency department (ED) or inpatient visit at 238 U.S. hospitals during March-December 2020, 28.3% had overweight and 50.8% had obesity. Overweight and obesity were risk factors for invasive mechanical ventilation, and obesity was a risk factor for hospitalization and death, particularly among adults aged <65 years. Risks for hospitalization, ICU admission, and death were lowest among patients with BMIs of 24.2 kg/m , 25.9 kg/m , and 23.7 kg/m , respectively, and then increased sharply with higher BMIs. Risk for invasive mechanical ventilation increased over the full range of BMIs, from 15 kg/m to 60 kg/m . As clinicians develop care plans for COVID-19 patients, they should consider the risk for severe outcomes in patients with higher BMIs, especially for those with severe obesity. These findings highlight the clinical and public health implications of higher BMIs, including the need for intensive COVID-19 illness management as obesity severity increases, promotion of COVID-19 prevention strategies including continued vaccine prioritization (6) and masking, and policies to ensure community access to nutrition and physical activities that promote and support a healthy BMI.