key: cord-0801878-yub2cqz6
authors: Lighter, Jennifer; Phillips, Michael; Hochman, Sarah; Sterling, Stephanie; Johnson, Diane; Francois, Fritz; Stachel, Anna
title: Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission
date: 2020-04-09
journal: Clin Infect Dis
DOI: 10.1093/cid/ciaa415
sha: 75e9a2617c22cb59caccee924c3eee075c3a1259
doc_id: 801878
cord_uid: yub2cqz6

nan

A c c e p t e d M a n u s c r i p t Dear Editor, Risk factors for infectious disease severity are determined by the pathogen, host and environment [1] . Covid-19 disease, caused by SARS-CoV-2 infection includes a spectrum of illness; from asymptomatic infection [2] to severe pneumonia characterized by acute respiratory injury in about 20% of patients presenting to medical care [3] . The risk factors associated with disease severity, included increased age, diabetes, immune suppression and organ failure [3] . Recognition of risk factors for morbidity and mortality is important to determine prevention strategies as well as to target high-risk populations for potential therapeutics.

We performed a retrospective analysis of BMI stratified by age in Covid-19-positive symptomatic patients who presented to a large academic hospital system in New York City. Patients presented to the ED with signs of respiratory distress were admitted to the hospital. Critical care was defined based on intensive care accommodation status or invasive ventilator documentation in our electronic health record. Patients who were PCR-positive for Covid-19 during March 4, 2020-April 4, 2020 were extracted from our electronic health record system and analyzed with a chisquare Wald test using SAS v9.4 (SAS Institute, Care NC).

Of the 3,615 individuals who tested positive for Covid-19, 775 (21%) had a body mass index (BMI) 30-34, and 595 (16% of the total cohort) had a BMI >35. There were 1,853 (51%) patients discharged from the ED, 1,331 (37%) were admitted to the hospital in acute care and 431 (12%) were either directly admitted or transferred to the ICU during admission. During analysis we found significant difference in admission and ICU care only in patients <60 years of age with varying BMIs (Table 1) Patients aged <60 years with a BMI between 30-34 were 2.0 (95% 1.6-2.6, p<0.0001) and 1.8 (95% CI 1.2-2.7, p=0.006) times more likely to be admitted to acute and critical care, respectively, compared to individuals with a BMI <30 (Table 1) 

A c c e p t e d M a n u s c r i p t years were 2.2 (95% CI 1.7-2.9, p<.0001) and 3.6 (95% CI 2.5-5.3, p=<.0001) times more likely to be admitted to acute and critical care compared to patients in the same age category who had BMI <30.

Though patients aged <60 years are generally considered a lower risk group of Covid-19 disease severity, based on data from our institution, obesity appears to be a previously unrecognized risk factor for hospital admission and need for critical care. This has important and practical implications, where nearly 40% of adults in the US are obese with a BMI >30 [4] . The BMI range of individuals in this study appears representative of the nation, as 36% of the patients have a BMI >30.

There is geographic variation in reported mortality, as South Korea, China and Italy report case fatality rates of 0.8, 2.3 and 7.2, respectively [5] and regional risk factors such as prevalence of smoking, pollution or aging population has been cited. Unfortunately, obesity in people <60 years is a newly identified epidemiologic risk factor which may contribute to increased morbidity rates experienced in the US. There are no financial disclosures to report on any of the authors M a n u s c r i p t 

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