AHA Study Links 4 Major Conditions to More than 60% of COVID-19 Hospitalizations

Dariush Mozaffarian, MD, DrPH

Results of a modeling study by investigators at Tufts University suggest nearly two-thirds of all COVID-19 hospitalizations can be attributed to the presence of four specific preexisting conditions.

An analysis that included data from more than 900,000 COVID-19 hospitalizations, results indicate 64% of hospitalizations were attributable to obesity, hypertension, diabetes, and heart failure—with more than 30% of all hospitalizations attributable to obesity alone.

"While newly authorized COVID-19 vaccines will eventually reduce infections, we have a long way to go to get to that point. Our findings call for interventions to determine whether improving cardiometabolic health will reduce hospitalizations, morbidity, and health care strains from COVID-19," said Dariush Mozaffarian, MD, DrPH, lead investigator and dean of the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University, in a statement. "We know that changes in diet quality alone, even without weight loss, rapidly improve metabolic health within just six to eight weeks. It's crucial to test such lifestyle approaches for reducing severe COVID-19 infections, both for this pandemic and future pandemics likely to come."

With previous observational studies linking the aforementioned cardiometabolic conditions to increased risk of severe outcomes with COVID-19, Mozaffarian and colleagues from the Friedman School sought to assess absolute and proportional COVID-19 hospitalizations attributable to each condition, jointly and separately, and according to race/ethnicity, age, and sex. Designed as a comparative risk assessment, investigators chose the NHANES 2015-2018 for cardiometabolic conditions and Centers for Disease Control and Prevention’s Coronavirus Disease 2019–Associated Hospitalization Surveillance Network (COVID-NET) database and from the COVID Tracking Project for COVID-19 hospitalizations as data sources for their study.

Investigators identified a total of 906,849 hospitalizations for COVID-19 among US adults that had occurred as of November 18, 2020. When assessing the proportion of hospitalizations attributable to each disease separately, results of the model indicated 274,322 (30.2%) were attributable to obesity, 237,738 (26.2%) were attributable to hypertension, 185,678 (20.5%) were attributable to diabetes, and 106,139 (11.7.%) were attributable to heart failure. When assessing the conditions jointly, results indicated the four conditions accounted for 575,419 (63.5%) of the 906,849 hospitalizations. Investigators pointed out further analysis suggested 10% reductions in national prevalence rates of each condition could have prevented approximately 11% of COVID-19 hospitalizations.

Like many previous studies, the investigators’ analysis also revealed disparities in COVID-19 attributable to these conditions based age and race/ethnicity. Specific disparities highlighted within the study included age-based disparities in hospitalizations attributable to diabetes and increased attributability to all four conditions among Black adults than White adults. Investigators also noted some disparities appeared to become greater when combing age and race/ethnicity into comparative models.

"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. It's also important for providers to be aware of the health disparities people with these conditions often face," said first investigator Meghan O'Hearn, a doctoral candidate at the Friedman School, in the aforementioned statement.

Investigators cautioned clinicians to consider limitations within their study before overinterpreting the results. These limitations included inability to prove causation and the inability to prove improvements will reduce risk of COVID-19 hospitalization.

This study, “Coronavirus Disease 2019 Hospitalizations Attributable to Cardiometabolic Conditions in the United States: A Comparative Risk Assessment Analysis,” was published in the Journal of the American Heart Association.