NIH: Most US Covid hospitalizations aren't due to Covid, rather to 4 conditions: obesity, high blood pressure, diabetes, and heart failure. Without those conditions, 64% of Covid hospitalizations wouldn’t be needed-NIH, Tufts Study, 3/9/21

“64% of the hospitalizations might have been prevented if not for the four conditions.”

March 9, 2021, “Most COVID-19 hospitalizations due to four conditions,” NIH.gov, Erin Bryant

“At a Glance: *A study estimated that nearly two-thirds of COVID-19 hospitalizations in the U.S. could be attributed to obesity, diabetes, hypertension, and heart failure….*The findings give insight into how underlying conditions contribute to hospitalizations during the pandemic.

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“Underlying medical conditions account for many COVID-19 hospitalizations. xavierarnau / E+ via Getty Images”

“Studies show that certain common medical conditions put people at higher risk for severe illness from COVID-19. These include metabolic disorders like type 2 diabetes and obesity, as well as heart conditions like high blood pressure (hypertension) and heart failure. People with these four conditions are more likely to be hospitalized with COVID-19.

To better understand how these conditions affect hospitalizations, a research team led by Meghan O’Hearn and Dr. Dariush Mozaffarian of Tufts University developed a statistical model. They incorporated data on the association of these four underlying conditions with COVID-19 hospitalizations in the U.S. They also included national data on COVID-19 hospitalizations and prevalence of the conditions by age, sex, and race/ethnicity.

Based on this data, the model calculated the percentage of COVID-19 hospitalizations that could have been prevented without these four underlying conditions. Results were published in the Journal of the American Heart Association on February 25, 2021.”…

[“CONCLUSIONS: A substantial proportion of US COVID‐19 hospitalizations appear attributable to major cardiometabolic conditions."]

(continuing): “The researchers estimated that more than 900,000 COVID-19 hospitalizations occurred through November 2020. Based on their model,

30% of these hospitalizations were attributable to obesity,

26% to hypertension [high blood pressure],

21% to diabetes, and

12% to heart failure.

These people would still have been infected with COVID-19, but likely would not have been sick enough to need hospitalization.

More than one of these conditions are often present in the same person. The model also estimated hospitalizations due to different combinations. The numbers weren’t simply additive. In total, 64% of the hospitalizations might have been prevented if not for the four conditions.

The model suggested that COVID-19 hospitalizations due to these conditions varied by age. Older adults with diabetes, heart failure, or hypertension were more likely to be hospitalized than younger people with the same condition. However, obesity affected COVID-19 hospitalization risk similarly across age groups. 

Race/ethnicity also resulted in disparities in COVID-19 hospitalizations due to these conditions. Black adults had the highest proportion of hospitalizations attributable to all four conditions at any age. Other studies show that COVID-19 deaths have disproportionately affected Black and other minority communities.

This research further highlights the burden of heart and metabolic diseases in the U.S. Almost 3 in 4 U.S. adults is overweight or obese. Nearly half of people have prediabetes or diabetes.

All of the conditions examined in the study have been shown to impair the body’s immune response. This may be one reason COVID-19 causes more harm in people with these underlying conditions. Improving heart and metabolic health may help reduce hospitalizations from COVID-19.

“Medical providers should educate patients who may be at risk for severe COVID-19 and consider promoting preventive lifestyle measures, such as improved dietary quality and physical activity, to improve overall cardiometabolic health,” says O’Hearn.”

—by Erin Bryant

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• Coronavirus (COVID-19)
• Coronavirus Prevention Network(link is external)
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References: Coronavirus Disease 2019 Hospitalizations Attributable to Cardiometabolic Conditions in the United States: A Comparative Risk Assessment Analysis. O’Hearn M, Liu J, Cudhea F, Micha R, Mozaffarian D. J Am Heart Assoc. 2021 Feb;10(5):e019259. doi: 10.1161/JAHA.120.019259. Epub 2021 Feb 25. PMID: 33629868.

Funding: NIH’s National Heart, Lung, and Blood Institute (NHLBI).”

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Added: “What are the clinical implications?” Journal of American Heart Assn., 2/25/21

“Multiple reports consistently demonstrate that poor cardiometabolic health is a major risk factor for increased COVID‐19 severity, including higher risks of hospitalizations and in‐hospital mortality.², ³, ⁴ A meta‐analysis of patients with COVID‐19 in China found that hypertension, cardiovascular diseases, and diabetes mellitus were each 2‐fold to 3‐fold more prevalent among severe cases than nonsevere cases.⁵ US reports similarly demonstrate a much higher prevalence of underlying cardiometabolic conditions among hospitalized cases and severe cases of COVID‐19 compared with infected individuals who do not suffer hospitalization or severe illness.², ⁶, ⁷ In a multivariable‐adjusted investigation of COVID‐19 in New York City, obesity, diabetes mellitus, hypertension, and heart failure were independent predictors of hospitalization, with many of these conferring the highest risks after advanced age.² In the most recent Centers for Disease Control and Prevention (CDC) analysis of available national data among individuals diagnosed with COVID‐19, a 35‐year‐old with diabetes mellitus, hypertension, cardiovascular disease, obesity, or other chronic conditions had a similar risk of COVID‐19 related hospitalization as a 75‐year‐old with none of these conditions, and a similar risk of COVID‐19–related death as a 65‐year‐old with none: a dramatic “biologic aging” effect of poor metabolic health on risk of severity of a viral infection such as COVID‐19.⁶

These heightened risks for COVID‐19 hospitalization are alarming given the ubiquity of cardiometabolic diseases. Nearly half of American adults are diabetic or prediabetic,⁸ nearly half have hypertension,⁹ and nearly 3 in 4 are overweight or obese.¹⁰ In sum, diet‐attributable chronic diseases are the leading cause of morbidity, mortality, and healthcare spending in the United States.¹¹ Tremendous disparities by race/ethnicity are also evident in both COVID‐19 deaths and burdens of cardiometabolic conditions.⁷, ¹², ¹³, ¹⁴ Cardiometabolic conditions could be contributing to a substantial proportion of COVID‐19 hospitalizations in the United States as well as to associated health disparities, exacerbating strains on hospital bed utilization, personal protective equipment supplies, availability of mechanical ventilators, and the healthcare workforce.

Given the extant burdens of cardiometabolic conditions, consistent evidence for strong associations between cardiometabolic conditions and COVID‐19 severity and the high rates of COVID‐19 hospitalizations in the United States, there is a need to quantify and compare the extent to which cardiometabolic conditions may be contributing to national COVID‐19 hospitalizations and associated health disparities. To address these questions, we used a comparative risk assessment modeling framework to estimate the proportions and numbers of COVID‐19 hospitalizations attributable to 4 major cardiometabolic risk factors, individually and jointly, among US adults overall and according to age, sex, and race/ethnicity.”

 

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