Sex Disparity in the Effect of Obesity in Hospitalized COVID-19 Patients: A Retrospective Cohort Study From the New York City Metropolitan Area

Abstract

Introduction: Obesity has been recognized as a risk factor for poor outcomes in coronavirus disease 2019 illness. We analyzed the impact of patient characteristics including obesity on hospital mortality and specifically analyzed the effect of obesity by body mass index (BMI) class and by sex.Methods: This retrospective case series included adult patients consecutively hospitalized with confirmed COVID-19 illness between March 12, 2020 and May 13, 2020, at a teaching hospital in the New York City (NYC) metropolitan area. Data were manually extracted from electronic health records by the authors and included demographics, comorbidities, laboratory parameters, and outcomes (hospital mortality or discharge). We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death.Results: Some 348 patients were included in this study, of whom 207 were discharged and 141 died in the hospital. Multivariable regression showed increasing odds of in-hospital death with older age and excess weight. Interestingly obesity increased mortality in women [odds ratio (OR) 4.4, confidence interval (CI) (1.4-13.5) p=0.01] but not among men [OR 1.4, CI (0.5-3.6) p=0.5]. Among women, the effect of excess weight on mortality was seen in a "dose-effect" fashion, with increasingly higher odds of mortality from progressively worsening obesity (OR ranging between 2.7 and 6.9). Out of all the comorbidities, only obesity positively correlated with peak levels of C-reactive protein (CRP). Conclusion:Advancing age is a risk factor for in-hospital death during COVID-19 illness. Obese women could be at a higher risk for mortality due to COVID-19 and should take extra precautions to prevent contamination by social distancing and other measures. Immunomodulators may be more effective in obese women affected by COVID-19. Further studies are needed to help elucidate this association.

Clinical Characteristics and Outcomes of COVID-19 Patients with Overweight and Obesity: Turkish Nationwide Cohort Study (TurCObesity)

“…Even though females and males are equally infected by COVID-19, most studies reported higher mortality rates due to COVID-19 in men [34,35], while another recent study suggested that obese women could be at a higher risk for mortality due to COVID-19 [36]. Sex-specific differences in genes encoding SARS-CoV2 entry receptors, the effect of sex hormones on immune response, and the association of more common risk factors in males may have a role in the development of these adverse outcomes [37].…”

Sex differences in comorbidities and COVID-19 mortality–Report from the real-world data

“…coronary artery disease, ischemic heart disease, or chronic obstructive pulmonary disease highlighted in the major case series since the pandemic, whereas female patients were more likely to have dementia or obesity at the diagnosis of COVID-19 (1,(4)(5)(6)(7). The prevalence and impact of diabetes, liver disease, or chronic kidney disease in COVID-19 varied by sex and region (1)(2)(3)(4)(8)(9)(10). These findings suggest a heterogeneous effect of comorbidities on COVID-19 severe outcomes in mens vs. women but remain to be further clarified.…”

Obesity as a Risk Factor for Complications and Mortality in Individuals with SARS-CoV-2: A Systematic Review

“…The remaining 35 studies were assessed for methodological quality using the Downs and Black scale. Of them, 27 studies were excluded due to low methodological quality, leaving 8 studies that met all the selection criteria [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ].…”

“…Of the 35 studies selected for the methodological assessment using the Downs and Black scale [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ], 1 study scored 6/17 [ 35 ], 3 scored 7/10 [ 36 , 37 , 38 ], 11 scored 8/17 [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ], 12 scored 9/17 [ 50 , 51 ,…”