Body Mass Index and Risk for COVID-19–Related Hospitalization, Intensive Care Unit Admission, Invasive Mechanical Ventilation, and Death

Body Mass Index and Risk for COVID-19–Related Hospitalization, Intensive Care Unit Admission, Invasive Mechanical Ventilation, and Death

Obesity is a recognized risk factor for severe COVID-19, possibly related to chronic inflammation that disrupts immune and thrombogenic responses to pathogens as well as to impaired lung function from excess weight. It also happens to represent a crossing health crisis in America. A large study was recently conducted by members of the CDC to disclose public health implications and findings associated. 

Study Details

Data for this study were obtained from PHD-SR, a large, hospital-based, all-payer database. Among the approximately 800 geographically dispersed U.S. hospitals that reported both inpatient and ED data to this database, 238 reported patient height and weight information and were selected for this study.

Among 3,242,649 patients aged ≥18 years with documented height and weight who received ED or inpatient care in 2020, a total of 148,494 (4.6%) had ICD-10-CM codes indicating a diagnosis of COVID-19 (Table). Among 71,491 patients hospitalized with COVID-19 (48.1% of all COVID-19 patients), 34,896 (48.8%) required ICU admission, 9,525 (13.3%) required invasive mechanical ventilation, and 8,348 (11.7%) died. Approximately 1.8% of patients had underweight, 28.3% had overweight, and 50.8% had obesity. Compared with the total PHD-SR cohort, patients with COVID-19–associated illness were older (median age of 55 years versus 49 years) and had a higher crude prevalence of obesity (50.8% versus 43.1%).

Reported Findings

Among 148,494 U.S. adults with COVID-19, a nonlinear relationship was found between body mass index (BMI) and COVID-19 severity, with lowest risks at BMIs near the threshold between healthy weight and overweight in most instances, then increasing with higher BMI. Overweight and obesity were risk factors for invasive mechanical ventilation. Obesity was a risk factor for hospitalization and death, particularly among adults aged <65 years.

Implications for Public Health 

These findings highlight clinical and public health implications of higher BMIs, including the need for intensive management of COVID-19–associated illness, continued vaccine prioritization and masking, and policies to support healthy behaviors.

Study Authors

Lead author Deborah Galuska, CDC

Corresponding author Lyudmyla Kompaniyets, PhD

Additional authors include Alyson B. Goodman, MD; Brook Belay, MD; David S. Freedman, PhD; Marissa S. Sucosky, MPH; Samantha J. Lange, MPH; Adi V. Gundlapalli, MD, PhD; Tegan K. Boehmer, PhD; and Heidi M. Blanck, PhD. Authors are from the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion or CDC COVID-19 Response Team.

Call to Action: To learn more about this study, visit the source.


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