Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 was first reported in China in late December, 2019, and has since evolved into a global pandemic. As of April 29, 2020, COVID-19 has been confirmed in more than 3 million individuals in 185 countries and regions, with an overall mortality rate of more than 6%.
Johns Hopkins University COVID-19 dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU).
Severe disease involves bilateral interstitial pneumonia requiring intensive care unit (ICU) ventilatory support and can evolve into adult respiratory distress syndrome with high mortality. The largest study of 1591 ICU patients from Italy reported a median age of 63 years, with only 203 patients (13%) younger than 51 years.
Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy.
Common comorbidities are hypertension, cardiovascular disease, type 2 diabetes, and, more rarely (42 [4%] of 1043), obstructive pulmonary disease. Similar data have been reported from China.
Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.
When the COVID-19 epidemic began in the USA, we anticipated a similar ICU population. News reports and communications from the US Federal Government had emphasised that COVID-19 was a particular problem for older people, and a resistance to social distancing and sheltering in place by younger people might have been informed by this idea. However, as the pandemic hit the Johns Hopkins Hospital in late March, 2020, younger patients began to be admitted to our ICU, many of whom were also obese. An informal survey of colleagues directing ICUs at other hospitals around the country yielded similar findings. At this time, news editorials were noting obesity as an underappreciated risk factor for COVID-19.
Americans are already too diseased to go back to work right now.
This risk is particularly relevant in the USA because the prevalence of obesity is around 40%, versus a prevalence of 6·2% in China, 20% in Italy, and 24% in Spain.
WHO Global Health Obsevatory (GHO) data: overweight and obesity.
With use of least squares univariate and multivariate linear regression, we examined the correlation between body-mass index (BMI) and age in patients with COVID-19 admitted to ICU at university hospitals at Johns Hopkins, University of Cincinnati, New York University, University of Washington, Florida Health, and University of Pennsylvania (appendix). Acquisition of the de-identified data for this analysis was approved by the Johns Hopkins University Institutional Review Board.
In our dataset of 265 patients (58% male patients), we found a significant inverse correlation between age and BMI, in which younger individuals admitted to hospital were more likely to be obese (figure). There was no difference by sex (p=0·9). The median BMI was 29·3 kg/m2, with only 25% of individuals having a BMI of less than 26 kg/m2, and 25% exceeding a BMI of 34·7 kg/m2.
FigureNegative correlation between BMI and age in 265 patients with coronavirus disease 2019 in intensive care units in the USA
GBD 2015 Obesity Collaborators Health effects of overweight and obesity in 195 countries over 25 years.
We conclude that in populations with a high prevalence of obesity, COVID-19 will affect younger populations more than previously reported. Public messaging to younger adults, reducing the threshold for virus testing in obese individuals, and maintaining greater vigilance for this at-risk population should reduce the prevalence of severe COVID-19 disease.
We thank John Wells, Judith Hochman, Yindalon Aphinyanaphongs, Barry J Byrne, Carmen Leon-Astudillo, Ali Ataya, Kenneth B Margulies, Srinivas Denduluri, Deeptankar DeMazumder, and Kevin D O’Brien for sharing de-identified data for the analysis in this Correspondence. The authors declare no competing interests.
Supplementary Material
References
1.
COVID-19 dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU).
2.
Grasselli G
Zangrillo A
Zanella A
et al.
Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy.
JAMA.2020; ()
3.
Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.
Lancet.2020; 395: 1054-1062
4.
Americans are already too diseased to go back to work right now.
5.
Global Health Obsevatory (GHO) data: overweight and obesity.
6.
Impact of obesity on influenza A virus pathogenesis, immune response, and evolution.
Front Immunol.2019; 101071
7.
Afshin A
Forouzanfar MH
et al.
GBD 2015 Obesity Collaborators
Health effects of overweight and obesity in 195 countries over 25 years.
