BMI identified as independent risk factor for COVID-19 ICU admission for African Americans
African Americans who are older, have a higher BMI or have a history of lung disease are at increased risk for ICU admission with COVID-19, according to a study published in Obesity.
“The COVID-19 epidemic in the United States tracks along well-documented and historical health disparities, with early data suggesting disproportionate morbidity and mortality within the African American community,” Christine M. Bojanowski, MD, assistant professor and co-director of the adult cystic fibrosis program at Tulane University School of Medicine, and colleagues wrote. “Despite this, there is a relative dearth of analysis relevant to the African American experience. In this study, we aim to describe the baseline characteristics of laboratory confirmed, COVID-19-positive African American patients and determine the possible risk factors.”
Bojanowski and colleagues conducted a cross-sectional study of all African Americans who tested positive for COVID-19 and were treated at a tertiary academic hospital between March 12 and April 9, 2020 (n = 158; mean age, 57 years; 61% women; mean BMI, 33.2 kg/m2). Those who were admitted to the ICU were considered to have severe disease course (n = 46), while non-severe cases were individuals who went to the emergency department or were admitted to the hospital and later discharged without an escalation in care (n = 112). Patient data were obtained through retrospective electronic medical records and included age, sex, BMI and comorbidities, such as diabetes mellitus, hypertension and obstructive lung disease.
Risk factors for ICU admission were older age (adjusted OR = 1.073; 95% CI, 1.033-1.114; P = .0003), elevated BMI (aOR = 1.115; 95% CI, 1.052-1.182; P = .0002) and presence of obstructive lung disease (aOR = 3.097; 95% CI, 1.137-8.437; P = .0270 ) as the three most prevalent risk factors for African Americans who were admitted to the ICU with COVID-19.
People admitted to the ICU were older (mean age 62 years vs. 55 years; P = .003) and had a higher BMI (36.5 kg/m2 vs. 31.9; P = .002) than those who were not admitted to the ICU. The odds of ICU admission nearly doubled with each BMI increase of 5 kg/m2 (OR = 1.72; 95% CI, 1.29-2.31) and tripled with each increase of 10 kg/m2 (OR = 2.97; 95% CI, 1.66-5.32).
“Prevention recommendations describe individuals with BMI greater than 40 [kg/m2] as being at ‘high risk’ for severe COVID-19 illness, whereas our results suggest that a lower threshold should be considered for this high-risk category,” researchers wrote.
People admitted to the ICU also had a higher prevalence of diabetes (63% vs. 42%; P = .016) and chronic kidney disease (23.9% vs. 8.9%; P = .012) than African American patients with non-severe cases.
“Appropriate management of obesity and the associated comorbidities of metabolic syndrome, as well as of the social determinants of health that underlie these conditions, is critical to addressing the evolving COVID-19 crisis,” researchers concluded.