Obesity Doubles Mortality in Patients Hospitalized for Severe Acute Respiratory Syndrome Coronavirus 2 in Paris Hospitals, France: A Cohort Study on 5,795 Patients

Abstract

Objective: Preliminary data from different cohorts of small sample size or with short follow-up indicate poorer prognosis in people with obesity compared with other patients. This study aims to precisely describe the strength of association between obesity in patients hospitalized with coronavirus disease 2019 (COVID-19) and mortality and to clarify the risk according to usual cardiometabolic risk factors in a large cohort.

Methods: This is a prospective cohort study including 5,795 patients aged 18 to 79 years hospitalized from February 1 to April 30, 2020, in the Paris area, with confirmed infection by severe acute respiratory syndrome coronavirus 2. Adjusted regression models were used to estimate the odds ratios (ORs) and 95% CIs for the mortality rate at 30 days across BMI classes, without and with imputation for missing BMI values.

Results: Eight hundred ninety-one deaths had occurred at 30 days. Mortality was significantly raised in people with obesity, with the following ORs for BMI of 30 to 35 kg/m² , 35 to 40 kg/m² , and >40 kg/m² : 1.89 (95% CI: 1.45-2.47), 2.79 (95% CI: 1.95-3.97), and 2.55 (95% CI: 1.62-3.95), respectively (18.5-25 kg/m² was used as the reference class). This increase holds for all age classes.

Conclusions: Obesity doubles mortality in patients hospitalized with COVID-19.

Figure 1

Study population flowchart.

Figure 2

Adjusted ORs (95% CIs) for mortality according to BMI from the multivariate regression analysis. OR, odds ratio.

Figure 3

Adjusted ORs (95% CIs) for mortality according to BMI for age class: (A) 18‐44, (B) 45‐64, and (C) 65‐79 years. OR, odds ratio.