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Association between Body Mass Index and Hospital Outcomes for COVID-19 Patients: A Nationwide Study
Waleed Khokher1, Saffa Iftikhar2, Andrew Abrahamian1
1Department of Internal Medicine, University of Toledo, Toledo, OH 43606, USA.
Insights
Severe obesity (BMI > 50) significantly increased COVID-19 mortality risk and need for mechanical ventilation. Obese patients had shorter hospital stays but similar charges, highlighting obesity as a critical factor in COVID-19 outcomes.
Area of Science:
- Medical research
- Epidemiology
- Public health
Background:
- Coronavirus disease 2019 (COVID-19) has caused substantial global morbidity and mortality.
- Limited data exists on the impact of specific body mass index (BMI) categories on hospital outcomes for COVID-19 patients.
Purpose of the Study:
- To investigate the relationship between body mass index (BMI) categories and hospital outcomes in COVID-19 patients.
- To analyze mortality, morbidity, and resource utilization based on BMI.
Main Methods:
- Utilized the 2020 Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) database.
- Identified adult patients hospitalized primarily for COVID-19 using ICD-10-CM codes.
- Performed adjusted regression analyses to compare outcomes across BMI categories.
Main Results:
- A total of 305,284 patients were analyzed, with 248,490 having obesity (BMI ≥ 30).
- Patients with BMI > 50 showed a 63% increased odds of in-hospital mortality and higher odds of requiring invasive mechanical ventilation (IMV).
- Obese patients had a shorter average hospital length of stay (LOS) but similar hospitalization charges compared to non-obese patients.
Conclusions:
- Obesity (BMI ≥ 40) is associated with significantly increased in-hospital mortality, IMV use, IMV-associated mortality, and septic shock in COVID-19 patients.
- Obese patients experienced shorter average hospital LOS.
- No significant difference in average hospitalization charges was observed between obese and non-obese patients.
Background:
Coronavirus disease 2019 (COVID-19) caused significant morbidity and mortality worldwide. There is limited information describing the hospital outcomes of COVID-19 patients in regard to specific body mass index (BMI) categories.
Methods:
We utilized the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) 2020 database to collect information on patients hospitalized for COVID-19 in the United States. Using the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) coding system, adult patients (≥18 years of age) with a primary hospitalization for COVID-19 were identified. Adjusted analyses were performed to assess for mortality, morbidity, and resource utilization, and compare the outcomes among patients categorized according to BMI.
Results:
A total of 305,284 patients were included in this study. Of them, 248,490 had underlying obesity, defined as BMI ≥ 30. The oldest patients were observed to have BMI < 19, while youngest patients were in the BMI > 50 category. BMI < 19 category had the highest crude in-hospital mortality rate. However, after adjusted regression, patients with BMI > 50 (adjusted odds ratio (aOR) 1.63, 95% CI 1.48-1.79, p-value < 0.001) had the highest increased odds, at 63%, of in-hospital mortality compared to all other patients in the study. Patients with BMI > 50 also had the highest increased odds of needing invasive mechanical ventilation (IMV) and mortality associated with IMV compared to all other patient, by 37% and 61%, respectively. Obese patients were noted to have shorter average hospital length of stay (LOS), by 1.07 days, compared to non-obese patients, but there was no significant difference in average hospitalization charges.
Conclusion:
Among obese patients primarily hospitalized with COVID-19, those with BMI ≥ 40 had significantly increased rates of all-cause in-hospital mortality, need for IMV, mortality associated with IMV, and septic shock. Overall, obese patients had shorter average hospital LOS, however, did not have significantly higher hospitalization charges.
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