April 2021

Most COVID-19 Hospitalizations Due to 4 Conditions

  • 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.

Studies show that certain common medical conditions put people at higher risk for severe illness from COVID-19: 2 metabolic disorders – type 2 diabetes and obesity; and 2 heart conditions – hypertension and heart failure. People with these 4 conditions are more likely to be hospitalized with COVID-19.

To better understand how these conditions affect hospitalizations, a research team led by doctoral student Meghan O’Hearn and Dariush Mozaffarian, MD, DrPH, of Tufts University, developed a statistical model. They incorporated data on the association of these 4 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 4 underlying conditions. Results were published in the Journal of the American Heart Association in February 2021.

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, 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.

The model also estimated hospitalizations due to different combinations of these comorbidities. The numbers weren’t simply additive. In total, 64% of the hospitalizations might have been prevented if not for the 4 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 all 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 4 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 living in U.S. 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.

Source: O’Hearn M, Liu J, Cudhea F, Micha R, Mozaffarian D. Coronavirus disease 2019 hospitalizations attributable to cardiometabolic conditions in the United States: a comparative risk assessment analysis. J Am Heart Assoc. 2021(5):e019259. doi: 10.1161/JAHA.120.019259.

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