Abstract

Context

A comprehensive understanding of the association between body mass index (BMI) and COVID-19 is still lacking.

Objective

To investigate associations between BMI and risk of COVID-19 diagnosis, hospitalisation with COVID-19, and death after a COVID-19 diagnosis or hospitalisation (subsequent death), accounting for potential effect modification by age and sex.

Design

Population-based cohort study.

Setting

Primary care records covering >80% of the Catalan population, linked to region-wide testing, hospital, and mortality records from March to May 2020.

Participants

Adults (≥18 years) with at least one measurement of weight and height.

Main outcome measures

Hazard ratios (HR) for each outcome.

Results

We included 2 524 926 participants. After 67 days of follow-up, 57 443 individuals were diagnosed with COVID-19, 10 862 were hospitalised with COVID-19, and 2467 had a subsequent death. BMI was positively associated with being diagnosed and hospitalised with COVID-19. Compared to a BMI of 22kg/m ², the HR (95%CI) of a BMI of 31kg/m ² was 1.22 (1.19-1.24) for diagnosis, and 1.88 (1.75-2.03) and 2.01 (1.86-2.18) for hospitalisation without and with a prior outpatient diagnosis, respectively. The association between BMI and subsequent death was J-shaped, with a modestly higher risk of death among individuals with BMIs ≤19kg/m ² and a more pronounced increasing risk for BMIs ≥40kg/m ². The increase in risk for COVID-19 outcomes was particularly pronounced among younger patients.

Conclusions

There is a monotonic association between BMI and COVID-19 diagnosis and hospitalisation risks, but a J-shaped one with mortality. More research is needed to unravel the mechanisms underlying these relationships.

中文翻译：

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体重指数和 COVID-19 诊断、住院和死亡风险：对 2 524 926 名加泰罗尼亚人的队列研究

摘要

语境

仍然缺乏对体重指数 (BMI) 与 COVID-19 之间关联的全面了解。

客观的

调查 BMI 与 COVID-19 诊断、COVID-19 住院以及 COVID-19 诊断或住院后死亡（随后死亡）风险之间的关联，并考虑年龄和性别的潜在影响。

设计

基于人群的队列研究。

环境

覆盖超过 80% 的加泰罗尼亚人口的初级保健记录，与 2020 年 3 月至 2020 年 5 月的全区域检测、医院和死亡率记录相关联。

参与者

至少有一项体重和身高测量值的成人（≥18 岁）。

主要观察指标

每个结果的风险比 (HR)。

结果

我们纳入了 2 524 926 名参与者。经过 67 天的随访，57443 人被诊断出患有 COVID-19，10862 人因 COVID-19 住院，2467 人随后死亡。BMI 与 COVID-19 的诊断和住院呈正相关。相比的22公斤/ m的BMI ²中，HR31千克的BMI的（95％CI）/米²为1.22（1.19-1.24），用于诊断，和1.88（1.75-2.03）和2.01（1.86-2.18），用于分别在没有和有先前门诊诊断的情况下住院。BMI和随后的死亡之间的相关性的J形，与死亡的与的BMI≤19kg/米个体中温和高风险²和的BMI≥40kg/ m的更明显增加风险². COVID-19 结果风险的增加在年轻患者中尤为明显。

结论

BMI 与 COVID-19 诊断和住院风险之间存在单调关联，但与死亡率呈 J 型关联。需要更多的研究来解开这些关系背后的机制。