Obesity, Ethnicity, and Risk of Critical Care, Mechanical Ventilation, and Mortality in Patients Admitted to Hospital with COVID-19: Analysis of the ISARIC CCP-UK Cohort.

J Kenneth Baillie,Malcolm G Semple,Clare L Gillies,Cameron Razieh,Isaric4C Investigators ,Thomas Yates,Yogini Chudasama,Francesco Zaccardi,Kamlesh Khunti,Peter J M Openshaw,Nazrul Islam,Melanie J Davies,Alex Rowlands,Claire A Lawson,Annemarie B Docherty

doi:10.1002/oby.23178

Abstract

ObjectiveThe aim of this study was to investigate the association of obesity with in‐hospital coronavirus disease 2019 (COVID‐19) outcomes in different ethnic groups.MethodsPatients admitted to hospital with COVID‐19 in the United Kingdom through the Clinical Characterisation Protocol UK (CCP‐UK) developed by the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) were included from February 6 to October 12, 2020. Ethnicity was classified as White, South Asian, Black, and other minority ethnic groups. Outcomes were admission to critical care, mechanical ventilation, and in‐hospital mortality, adjusted for age, sex, and chronic diseases.ResultsOf the participants included, 54,254 (age = 76 years; 45.0% women) were White, 3,728 (57 years; 41.1% women) were South Asian, 2,523 (58 years; 44.9% women) were Black, and 5,427 (61 years; 40.8% women) were other ethnicities. Obesity was associated with all outcomes in all ethnic groups, with associations strongest for black ethnicities. When stratified by ethnicity and obesity status, the odds ratios for admission to critical care, mechanical ventilation, and mortality in black ethnicities with obesity were 3.91 (3.13‐4.88), 5.03 (3.94‐6.63), and 1.93 (1.49‐2.51), respectively, compared with White ethnicities without obesity.ConclusionsObesity was associated with an elevated risk of in‐hospital COVID‐19 outcomes in all ethnic groups, with associations strongest in Black ethnicities.

Highlights

Obesity and ethnicity are well-described risk factors for coronavirus disease 2019 (COVID-19) outcomes (1-7)
We investigated associations of obesity and ethnicity with in-hospital critical care and mortality outcomes in patients admitted with COVID-1 9 using data from the Clinical Characterisation Protocol United Kingdom (UK) (CCP-U K), a preparedness protocol for severe emerging diseases developed by the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) cohort (20)
Of the 65,932 individuals included in this analysis, 54,254 (82.3%) were White, 3,728 (5.7%) South Asian, 2,523 (3.8%) Black, and 5,427 (8.8%) from other ethnic minorities: Table 1 shows the characteristics of the cohort

Summary

Introduction

Obesity and ethnicity are well-described risk factors for coronavirus disease 2019 (COVID-19) outcomes (1-7). Obesity and ethnicity were shown to be independent of each other as risk factors for COVID-1 9 outcomes, less is known about whether ethnicity acts to modify the strength of association observed with obesity or whether the risk remains consistent across different ethnic groups. As cardiometabolic diseases are known risk factors for COVID-19 outcomes (13-16), it is possible that obesity may act as a important risk factor for severe COVID-19 outcomes in minority ethnic communities Research supports this hypothesis, in which the risk of severe acute respiratory syndrome coronavirus 2 infection, severe disease, and COVID-19 mortality in minority ethnic communities has been shown to be magnified in the presence of obesity (17,18), this has not been confirmed in all studies (19). As minority ethnic groups cover heterogeneous populations, it remains uncertain whether associations between obesity and COVID-1 9 outcomes differ in all minority ethnic groups or how they apply to national in-hospital settings

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