What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: COVID-19 (n=543399). Intervention: Obesity vs. Non-obese patients. Primary outcome: Mortality (RR 1.42, 95% CI 1.24-1.63, p=<0.001).

February 5, 2021Open Access

Obesity and Mortality Among Patients Diagnosed With COVID-19: A Systematic Review and Meta-Analysis

Q: What are the key findings of this study?

Obesity was significantly associated with an increased risk of mortality among patients with COVID-19 (RR 1.42), particularly in patients older than 65 years and those with class III obesity.

Key Result

Obesity was significantly associated with an increased risk of mortality among patients with COVID-19 (RR 1.42), particularly in patients older than 65 years and those with class III obesity.

Study Design

Type

Meta-Analysis (n=543,399)

Structured PICO

Does obesity increase mortality in patients diagnosed with COVID-19?

Population

543,399 patients diagnosed with COVID-19 from 17 studies, evaluated for the association between obesity and mortality.

Exposure

Obesity (including Class I, Class II, and Class III)

Comparator

Patients without obesity

Outcome

Mortality of patients with COVID-19hard clinical

Obesity, particularly class III and in patients over 65 years of age, is significantly associated with increased mortality in patients diagnosed with COVID-19.

Main Result

Relative Risk: 1.42 (95% CI 1.24–1.63)

p-value: p=<0.001

Limitations

Could not compare risk among patients aged <65 due to data constraints.
Only one study reported about pneumonia as a high-risk factor for mortality.
Did not show the difference in the rate of mortality among various races and locations.

Abstract

Coronavirus disease 2019 (COVID-19) has already raised serious concern globally as the number of confirmed or suspected cases have increased rapidly. Epidemiological studies reported that obesity is associated with a higher rate of mortality in patients with COVID-19. Yet, to our knowledge, there is no comprehensive systematic review and meta-analysis to assess the effects of obesity and mortality among patients with COVID-19. We, therefore, aimed to evaluate the effect of obesity, associated comorbidities, and other factors on the risk of death due to COVID-19. We did a systematic search on PubMed, EMBASE, Google Scholar, Web of Science, and Scopus between January 1, 2020, and August 30, 2020. We followed Cochrane Guidelines to find relevant articles, and two reviewers extracted data from retrieved articles. Disagreement during those stages was resolved by discussion with the main investigator. The random-effects model was used to calculate effect sizes. We included 17 articles with a total of 543,399 patients. Obesity was significantly associated with an increased risk of mortality among patients with COVID-19 (RR adjust : 1.42 (95%CI: 1.24–1.63, p 0.001). The pooled risk ratio for class I, class II, and class III obesity were 1.27 (95%CI: 1.05–1.54, p = 0.01), 1.56 (95%CI: 1.11–2.19, p 0.01), and 1.92 (95%CI: 1.50–2.47, p 0.001), respectively). In subgroup analysis, the pooled risk ratio for the patients with stroke, CPOD, CKD, and diabetes were 1.80 (95%CI: 0.89–3.64, p = 0.10), 1.57 (95%CI: 1.57–1.91, p 0.001), 1.34 (95%CI: 1.18–1.52, p 0.001), and 1.19 (1.07–1.32, p = 0.001), respectively. However, patients with obesity who were more than 65 years had a higher risk of mortality (RR: 2.54; 95%CI: 1.62–3.67, p 0.001). Our study showed that obesity was associated with an increased risk of death from COVID-19, particularly in patients aged more than 65 years. Physicians should aware of these risk factors when dealing with patients with COVID-19 and take early treatment intervention to reduce the mortality of COVID-19 patients.

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