Abstract

BackgroundResearch regarding the association between severe obesity and in-hospital mortality is inconsistent. We evaluated the impact of body mass index (BMI) levels on mortality in the medical wards. The analysis was performed separately before and during the COVID-19 pandemic.MethodsWe retrospectively retrieved data of adult patients admitted to the medical wards at the Mount Sinai Health System in New York City. The study was conducted between January 1, 2011, to March 23, 2021. Patients were divided into two sub-cohorts: pre-COVID-19 and during-COVID-19. Patients were then clustered into groups based on BMI ranges. A multivariate logistic regression analysis compared the mortality rate among the BMI groups, before and during the pandemic.ResultsOverall, 179,288 patients were admitted to the medical wards and had a recorded BMI measurement. 149,098 were admitted before the COVID-19 pandemic and 30,190 during the pandemic. Pre-pandemic, multivariate analysis showed a “J curve” between BMI and mortality. Severe obesity (BMI > 40) had an aOR of 0.8 (95% CI:0.7–1.0, p = 0.018) compared to the normal BMI group. In contrast, during the pandemic, the analysis showed a “U curve” between BMI and mortality. Severe obesity had an aOR of 1.7 (95% CI:1.3–2.4, p < 0.001) compared to the normal BMI group.ConclusionsMedical ward patients with severe obesity have a lower risk for mortality compared to patients with normal BMI. However, this does not apply during COVID-19, where obesity was a leading risk factor for mortality in the medical wards. It is important for the internal medicine physician to understand the intricacies of the association between obesity and medical ward mortality.

Highlights

  • Research regarding the association between severe obesity and in-hospital mortality is inconsistent

  • The cohort included 179,288 patients that were admitted to the medical wards

  • The mortality rate was significantly higher during the COVID-19 pandemic (3.3% versus 2.2%, P < 0.001)

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Summary

Introduction

Research regarding the association between severe obesity and in-hospital mortality is inconsistent. There is a strong association between body weight and mortality in the general population [4]. Controversy exists regarding the effect of severe obesity on in-hospital mortality. Some studies have shown that obesity reduces overall inpatient mortality risk, a phenomenon termed as the “obesity paradox” [5,6,7], while others demonstrated an increased inpatient mortality risk [8, 9].

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