Obesity is associated with severe disease and mortality in patients with coronavirus disease 2019 (COVID-19): a meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of observational cohort/prognostic studies
PubMed 34348687 · doi:10.1186/s12889-021-11546-6
What was done
A systematic review and meta-analysis of studies searched across PubMed, EMBASE, Cochrane Library, and Web of Science evaluated the association of obesity with COVID-19 infection, severity, and mortality. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using fixed- or random-effects models, accompanied by meta-regression analyses.
What was found
Across 46 included studies comprising 625,153 patients, obesity versus non-obesity was associated with significantly higher odds of: - COVID-19 infection: OR 2.73 (95% CI 1.53–4.87; I² = 96.8%) - Hospitalization: OR 1.72 (95% CI 1.55–1.92; I² = 47.4%) - Clinically severe disease: OR 3.81 (95% CI 1.97–7.35; I² = 57.4%) - Mechanical ventilation: OR 1.66 (95% CI 1.42–1.94; I² = 41.3%) - Intensive care unit (ICU) admission: OR 2.25 (95% CI 1.55–3.27; I² = 71.5%) - Mortality: OR 1.61 (95% CI 1.29–2.01; I² = 83.1%)
Why it matters
This large meta-analysis aggregates data across more than 600,000 patients to demonstrate that obesity is consistently associated with worse clinical courses, critical care interventions, and mortality from COVID-19.
Limits
The underlying studies were observational, which precludes causal conclusions and introduces risk of residual confounding. Statistical heterogeneity was very high for several endpoints, including infection (I² = 96.8%) and mortality (I² = 83.1%). Specific definitions or cutoffs for obesity across the included studies were not detailed in the abstract.
Cited by
- supports COVID-19 disproportionately caused severe illness in individuals with metabolic dysfunction.