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Comparative Study
. 2021 Feb;10(5):e019259.
doi: 10.1161/JAHA.120.019259. Epub 2021 Feb 25.

Coronavirus Disease 2019 Hospitalizations Attributable to Cardiometabolic Conditions in the United States: A Comparative Risk Assessment Analysis

Meghan O'Hearn  1 , Junxiu Liu  1   2 , Frederick Cudhea  1 , Renata Micha  1 , Dariush Mozaffarian  1
Affiliations
Comparative Study

Coronavirus Disease 2019 Hospitalizations Attributable to Cardiometabolic Conditions in the United States: A Comparative Risk Assessment Analysis

Meghan O'Hearn et al. J Am Heart Assoc. 2021 Feb.

Erratum in

Abstract

BACKGROUND Risk of coronavirus disease 2019 (COVID-19) hospitalization is robustly linked to cardiometabolic health. We estimated the absolute and proportional COVID-19 hospitalizations in US adults attributable to 4 major US cardiometabolic conditions, separately and jointly, and by race/ethnicity, age, and sex. METHODS AND RESULTS We used the best available estimates of independent associations of cardiometabolic conditions with a risk of COVID-19 hospitalization; nationally representative data on cardiometabolic conditions from the National Health and Nutrition Examination Survey 2015 to 2018; and US COVID-19 hospitalizations stratified by age, sex, and race/ethnicity from the Centers for Disease Control and Prevention's Coronavirus Disease 2019-Associated Hospitalization Surveillance Network database and from the COVID Tracking Project to estimate the numbers and proportions of COVID-19 hospitalizations attributable to diabetes mellitus, obesity, hypertension, and heart failure. Inputs were combined in a comparative risk assessment framework, with probabilistic sensitivity analyses and 1000 Monte Carlo simulations to jointly incorporate stratum-specific uncertainties in data inputs. As of November 18, 2020, an estimated 906 849 COVID-19 hospitalizations occurred in US adults. Of these, an estimated 20.5% (95% uncertainty interval [UIs], 18.9-22.1) of COVID-19 hospitalizations were attributable to diabetes mellitus, 30.2% (UI, 28.2-32.3) to total obesity (body mass index ≥30 kg/m2), 26.2% (UI, 24.3-28.3) to hypertension, and 11.7% (UI, 9.5-14.1) to heart failure. Considered jointly, 63.5% (UI, 61.6-65.4) or 575 419 (UI, 559 072-593 412) of COVID-19 hospitalizations were attributable to these 4 conditions. Large differences were seen in proportions of cardiometabolic risk-attributable COVID-19 hospitalizations by age and race/ethnicity, with smaller differences by sex. CONCLUSIONS A substantial proportion of US COVID-19 hospitalizations appear attributable to major cardiometabolic conditions. These results can help inform public health prevention strategies to reduce COVID-19 healthcare burdens.

Keywords: COVID‐19; diabetes mellitus; heart failure; hypertension; obesity.

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Conflict of interest statement

Drs Mozaffarian and Micha report receipt of grants from the National Institutes of Health during the conduct of this study. Dr Mozaffarian reports research funding from the Gates Foundation, and the Rockefeller Foundation; personal fees from The Global Organization for EPA & DHA omega‐3s (GOED), Barilla, Bunge, Indigo Agriculture, Motif FoodWorks, Amarin, Cleveland Clinic Foundation, and America's Test Kitchen (modest); and Acasti Pharma and Danone (significant); participating on scientific advisory boards of start‐up companies focused on innovations for health, including Brightseed, Calibrate, DayTwo, Elysium Health, Filtricine, Foodome, HumanCo, and Tiny Organics (significant); and chapter royalties from UpToDate (modest); all outside the submitted work. Dr Micha reports research funding from Bill & Melinda Gates Foundation, Nestle, and Danone, personal fees from Bunge, and Development Initiatives for serving as the co‐chair of the Global Nutrition Report, all outside the submitted work. The remaining authors have no disclosures to report.

Figures

Figure 1
Figure 1. Joint distributions of total obesity, hypertension, and diabetes mellitus in the US adult population, National Health and Nutrition Examination Survey 2015 to 2018.
Heart failure (2.4% prevalence in the adult US population) was omitted for visual clarity (see text and Table 3).
Figure 2
Figure 2. Proportion of COVID‐19 hospitalizations among US adults attributable to diabetes mellitus (top panel), hypertension (middle panel), and heart failure (bottom panel), overall and stratified by age, sex, and age–race/ethnicity.
COVID‐19 indicates coronavirus disease 2019.
Figure 3
Figure 3. Proportion of COVID‐19 hospitalizations among US adults attributable to obesity (BMI 30–40 kg/m2; top panel), severe obesity (BMI >40 kg/m2; middle panel), and total obesity (BMI ≥30 kg/m2; bottom panel), overall and stratified by age, sex, and age–race/ethnicity.
BMI indicates body mass index; and COVID‐19, coronavirus disease 2019.
Figure 4
Figure 4. Proportion of COVID‐19 hospitalizations among US adults attributable to 4 cardiometabolic risk factors—total obesity (body mass index ≥30 kg/m2), diabetes mellitus, hypertension, and heart failure—jointly, overall, and stratified by age, sex, and age–race/ethnicity.
COVID‐19 indicates coronavirus disease 2019.
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