Background Due to its large impact on human health, socio-economic status (SES) could at least partially influence the established association between obesity and coronavirus disease 2019 (COVID-19) severity. To estimate the independent effect of body size and SES on the clinical manifestations of COVID-19, we conducted a Mendelian randomization (MR) study. Methods Applying two-sample MR approaches, we evaluated the effects of body mass index (BMI, n = 322 154), waist circumference (WC, n = 234 069), hip circumference (n = 213 019) and waist–hip ratio (n = 210 088) with respect to three COVID-19 outcomes: severe respiratory COVID-19 (cases = 8779, controls = 1 000 875), hospitalized COVID-19 (cases = 17 992, controls = 1 810 493) and COVID-19 infection (cases = 87 870, controls = 2 210 804). Applying a multivariable MR (MVMR) approach, we estimated the effect of these anthropometric traits on COVID-19 outcomes accounting for the effect of SES assessed as household income (n = 286 301). Results BMI and WC were associated with severe respiratory COVID-19 [BMI: odds ratio (OR) = 1.51, CI = 1.24–1.84, P = 3.01e-05; WC: OR = 1.48, 95% CI = 1.15–1.91, P = 0.0019] and hospitalized COVID-19 (BMI: OR = 1.50, 95% CI = 1.32–1.72, P = 8.83e-10; WC: OR = 1.41, 95% CI = 1.20–1.67, P = 3.72e-05). Conversely, income was associated with lower odds of severe respiratory (OR = 0.70, 95% CI = 0.53–0.93, P = 0.015) and hospitalized COVID-19 (OR = 0.78, 95% CI = 0.66–0.92, P = 0.003). MVMR analyses showed that the effect of these obesity-related traits on increasing the odds of COVID-19 negative outcomes becomes null when accounting for income. Conversely, the association of income with lower odds of COVID-19 negative outcomes is not affected when including the anthropometric traits in the multivariable model. Conclusion Our findings indicate that SES contributes to the effect of obesity-related traits on COVID-19 severity and hospitalization.

中文翻译：

---

肥胖相关特征与 COVID-19 严重程度和住院率的关联受社会经济地位的影响：一项多变量孟德尔随机研究

背景 由于其对人类健康的巨大影响，社会经济地位 (SES) 可能至少部分影响肥胖与 2019 冠状病毒病 (COVID-19) 严重程度之间已建立的关联。为了估计体型和 SES 对 COVID-19 临床表现的独立影响，我们进行了一项孟德尔随机化 (MR) 研究。方法 采用双样本 MR 方法，我们评估了体重指数（BMI，n = 322 154）、腰围（WC，n = 234 069）、臀围（n = 213 019）和腰臀比（ n = 210 088）关于三个 COVID-19 结果：严重呼吸道 COVID-19（病例 = 8779，对照 = 1 000 875），住院 COVID-19（病例 = 17 992，对照 = 1 810 493）和 COVID- 19 例感染（病例 = 87 870，对照 = 2 210 804）。应用多变量 MR (MVMR) 方法，我们估计了这些人体测量特征对 COVID-19 结果的影响，并考虑了作为家庭收入评估的 SES 的影响 (n = 286 301)。结果 BMI 和 WC 与严重呼吸道 COVID-19 相关 [BMI：比值比 (OR) = 1.51，CI = 1.24–1.84，P = 3.01e-05；WC：OR = 1.48，95% CI = 1.15–1.91，P = 0.0019] 和住院的 COVID-19（BMI：OR = 1.50，95% CI = 1.32–1.72，P = 8.83e-10；WC：OR = 1.41 , 95% CI = 1.20–1.67, P = 3.72e-05)。相反，收入与严重呼吸系统疾病（OR = 0.70，95% CI = 0.53–0.93，P = 0.015）和住院 COVID-19（OR = 0.78，95% CI = 0.66–0.92，P = 0.003）的较低几率相关. MVMR 分析表明，这些与肥胖相关的特征对增加 COVID-19 负面结果几率的影响在考虑收入时变得无效。反过来，当在多变量模型中包含人体测量特征时，收入与 COVID-19 负面结果几率较低的关联不受影响。结论 我们的研究结果表明，SES 有助于肥胖相关特征对 COVID-19 严重程度和住院率的影响。