bims-covirf Biomed News
on COVID19 risk factors
Issue of 2020‒09‒06
ten papers selected by
Catherine Rycroft
BresMed


  1. Int J Epidemiol. 2020 Sep 05. pii: dyaa140. [Epub ahead of print]
    Reilev M, Kristensen KB, Pottegård A, Lund LC, Hallas J, Ernst MT, Christiansen CF, Sørensen HT, Johansen NB, Brun NC, Voldstedlund M, Støvring H, Thomsen MK, Christensen S, Gubbels S, Krause TG, Mølbak K, Thomsen RW.
      BACKGROUND: Population-level knowledge on individuals at high risk of severe and fatal coronavirus disease 2019 (COVID-19) is urgently needed to inform targeted protection strategies in the general population.METHODS: We examined characteristics and predictors of hospitalization and death in a nationwide cohort of all Danish individuals tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from 27 February 2020 until 19 May 2020.
    RESULTS: We identified 11 122 SARS-CoV-2 polymerase chain reaction-positive cases of whom 80% were community-managed and 20% were hospitalized. Thirty-day all-cause mortality was 5.2%. Age was strongly associated with fatal disease {odds ratio [OR] 15 [95% confidence interval (CI): 9-26] for 70-79 years, increasing to OR 90 (95% CI: 50-162) for ≥90 years, when compared with cases aged 50-59 years and adjusted for sex and number of co-morbidities}. Similarly, the number of co-morbidities was associated with fatal disease [OR 5.2 (95% CI: 3.4-8.0), for cases with at least four co-morbidities vs no co-morbidities] and 79% of fatal cases had at least two co-morbidities. Most major chronic diseases were associated with hospitalization, with ORs ranging from 1.3-1.4 (e.g. stroke, ischaemic heart disease) to 2.6-3.4 (e.g. heart failure, hospital-diagnosed kidney disease, organ transplantation) and with mortality with ORs ranging from 1.1-1.3 (e.g. ischaemic heart disease, hypertension) to 2.5-3.2 (e.g. major psychiatric disorder, organ transplantation). In the absence of co-morbidities, mortality was <5% in persons aged ≤80 years.
    CONCLUSIONS: In this nationwide population-based COVID-19 study, increasing age and multimorbidity were strongly associated with hospitalization and death. In the absence of co-morbidities, the mortality was, however, <5% until the age of 80 years.
    Keywords:  COVID-19; SARS-CoV-2; death; epidemiology; hospitalization; infectious disease; population-based; predictors
    DOI:  https://doi.org/10.1093/ije/dyaa140
  2. Med Clin (Engl Ed). 2020 Aug 28. 155(4): 143-151
    Soraya GV, Ulhaq ZS.
      Introduction and objectives: Common laboratory parameters are crucial in aiding coronavirus disease 2019 (COVID-19) case detection. This study aimed to determine the differences between laboratory parameters in (1) COVID-19 versus non-COVID-19 pneumonia, and (2) severe versus non-severe COVID-19 cases.Methods: Studies were collected until March 2020, and retrieved parameters include leukocyte, neutrophil, thrombocyte, and lymphocyte counts in addition to C-reactive protein (CRP), procalcitonin (PCT) and D-dimer levels. In the presence of heterogeneity, the random-effect model (REM) was used instead of the fixed-effect model (FEM).
    Results: Seven studies in the first analysis showed significantly lower leukocyte, neutrophil and platelet counts in COVID-19 pneumonia (SMD = -0.42, 95%CI -0.60 to -0.25, p < 0.00001, SMD = -0.23, 95%CI -0.41 to -0.06, p = 0.01, SMD = -0.54, 95%CI -0.91 to -0.16, p = 0.0005) compared to non-COVID-19 pneumonia. Twenty-six studies in the second analysis showed significantly lower lymphocyte and thrombocyte counts (SMD = -0.56, 95%CI -0.71 to -0.40, p < 0.0001, SMD = -0.32, 95%CI -0.49 to -0.15, p = 0.0002) and significantly higher leukocyte, neutrophil, D-dimer, and CRP (SMD = 0.31, 95%CI 0.07-0.56, p = 0.01; SMD = 0.44, 95%CI 0.24-0.64, p < 0.0001; SMD = 0.53, 95%CI 0.31-0.75, p < 0.00001; SMD = 0.97, 95%CI 0.70-1.24, p < 0.00001) in severe COVID-19 compared to non-severe COVID-19.
    Conclusions: In conclusion, thrombocyte count is key in both diagnosis and prognosis. Low leukocyte and neutrophil counts are markers of COVID-19 infection, but contrastingly higher counts indicate progressive COVID-19. And although lymphocyte, D-dimer and CRP levels did not demonstrate diagnostic value, all indicate severity of COVID-19. Confirmation of these findings should be performed in future studies.
    Keywords:  COVID-19; Diagnosis; Laboratory parameters; SARS-CoV-2
    DOI:  https://doi.org/10.1016/j.medcle.2020.05.004
  3. Am J Cardiol. 2020 Aug 27. pii: S0002-9149(20)30897-3. [Epub ahead of print]
    Cetinkal G, Kocas BB, Ser OS, Kilci H, Keskin K, Ozcan SN, Verdi Y, Zeren MI, Demir T, Kilickesmez K.
      Since the modified CHA2DS2VASC (M-CHA2DS2VASc) risk score (RS) includes the prognostic risk factors for COVID-19; we assumed that it might predict in-hospital mortality and identify high risk patients at an earlier stage compared with troponin increase and neutrophil-lymphocyte ratio (NLR). We aimed to investigate whether M-CHA2DS2VASC RS is an independent predictor of mortality in patients hospitalized with COVID-19 and to compare its discriminative ability with troponin increase and NLR in terms of predicting mortality. 694 patients were retrospectively analyzed and divided into three groups according to M-CHA2DS2VASC RS which was simply created by changing gender criteria of the CHA2DS2VASC RS from female to male (Group 1, score 0-1 (n= 289); group 2, score 2-3 (n=231) and group 3, score ≥4 (n=174)). Adverse clinical events were defined as in-hospital mortality, admission to intensive care unit, need for high-flow oxygen and/or intubation. As the M-CHA2DS2VASC RS increased, adverse clinical outcomes were also significantly increased (Group 1, 3.8%; group 2, 12.6%; group 3, 20.8%; p<0.001 for in-hospital mortality). The multivariate logistic regression analysis showed that M-CHA2DS2VASC RS, troponin increase and NLR were independent predictors of in-hospital mortality (p=0.005, odds ratio 1.29 per scale for M-CHA2DS2VASC RS). In ROC analysis, comparative discriminative ability of M-CHA2DS2VASC RS was superior to CHA2DS2VASC RS score. Area under the curve (AUC) values for in-hospital mortality were 0.70 and 0.64 respectively. (AUCM-CHA2DS2-VASc vs. AUCCHA2DS2-VASc z test=3.56, p 0.0004) In conclusion, admission M-CHA2DS2VASc RS may be a useful tool to predict in-hospital mortality in patients with COVID-19.
    Keywords:  COVID-19; in-hospital mortality; modified CHA2DS2VASc score
    DOI:  https://doi.org/10.1016/j.amjcard.2020.08.040
  4. Clin Infect Dis. 2020 Aug 29. pii: ciaa1198. [Epub ahead of print]
    Boulle A, Davies MA, Hussey H, Ismail M, Morden E, Vundle Z, Zweigenthal V, Mahomed H, Paleker M, Pienaar D, Tembo Y, Lawrence C, Isaacs W, Mathema H, Allen D, Allie T, Bam JL, Buddiga K, Dane P, Heekes A, Matlapeng B, Mutemaringa T, Muzarabani L, Phelanyane F, Pienaar R, Rode C, Smith M, Tiffin N, Zinyakatira N, Cragg C, Marais F, Mudaly V, Voget J, Davids J, Roodt F, van Zyl Smit N, Vermeulen A, Adams K, Audley G, Bateman K, Beckwith P, Bernon M, Blom D, Boloko L, Botha J, Boutall A, Burmeister S, Cairncross L, Calligaro G, Coccia C, Corin C, Daroowala R, Dave JA, De Bruyn E, De Villiers M, Deetlefs M, Dlamini S, Du Toit T, Endres W, Europa T, Fieggan G, Figaji A, Frankenfeld P, Gatley E, Gina P, Govender E, Grobler R, Gule MV, Hanekom C, Held M, Heynes A, Hlatswayo S, Hodkinson B, Holtzhausen J, Hoosain S, Jacobs A, Kahn M, Kahn T, Khamajeet A, Khan J, Khan R, Khwitshana A, Knight L, Kooverjee S, Krogscheepers R, Jacque Kruger J, Kuhn S, Laubscher K, Lazarus J, Le Roux J, Lee Jones S, Levin D, Maartens G, Majola T, Manganyi R, Marais D, Marais S, Maritz F, Maughan D, Mazondwa S, Mbanga L, Mbatani N, Mbena B, Meintjes G, Mendelson M, Möller E, Moore A, Ndebele B, Nortje M, Ntusi N, Nyengane F, Ofoegbu C, Papavarnavas N, Peter J, Pickard H, Pluke K, Raubenheimer PJ, Robertson G, Rozmiarek J, Sayed A, Scriba M, Sekhukhune H, Singh P, Smith E, Soldati V, Stek C, van den Berg R, van der Merwe LR, Venter P, Vermooten B, Viljoen G, Viranna S, Vogel J, Vundla N, Wasserman S, Zitha E, Lomas-Marais V, Lombard A, Stuve K, Viljoen W, Basson V, Le Roux S, Linden-Mars E, Victor L, Wates M, Zwanepoel E, Ebrahim N, Lahri S, Mnguni A, Crede T, de Man M, Evans K, Hendrikse C, Naude J, Parak M, Szymanski P, Van Koningsbruggen C, Abrahams R, Allwood B, Botha C, Henndrik Botha M, Broadhurst A, Claasen D, Daniel C, Dawood R, du Preez M, Du Toit N, Erasmus K, Koegelenberg CFN, Gabriel S, Hugo S, Jardine T, Johannes C, Karamchand S, Lalla U, Langenegger E, Louw E, Mashigo B, Mhlana N, Mnqwazi C, Moodley A, Moodley D, Moolla S, Mowlana A, Nortje A, Olivier E, Parker A, Paulsen C, Prozesky H, Rood J, Sabela T, Schrueder N, Sithole N, Sithole S, Taljaard JJ, Titus G, Van Der Merwe T, van Schalkwyk M, Vazi L, Viljoen AJ, Yazied Chothia M, Naidoo V, Alan Wallis L, Abbass M, Arendse J, Armien R, Bailey R, Bello M, Carelse R, Forgus S, Kalawe N, Kariem S, Kotze M, Lucas J, McClaughlin J, Murie K, Najjaar L, Petersen L, Porter J, Shaw M, Stapar D, Williams M, Aldum L, Berkowitz N, Girran R, Lee K, Naidoo L, Neumuller C, Anderson K, Begg K, Boerlage L, Cornell M, de Waal R, Dudley L, English R, Euvrard J, Groenewald P, Jacob N, Jaspan H, Kalk E, Levitt N, Malaba T, Nyakato P, Patten G, Schneider H, Shung King M, Tsondai P, Van Duuren J, van Schaik N, Blumberg L, Cohen C, Govender N, Jassat W, Kufa T, McCarthy K, Morris L, Hsiao NY, Marais R, Ambler J, Ngwenya O, Osei-Yeboah R, Johnson L, Kassanjee R, Tamuhla T.
      BACKGROUND: Risk factors for COVID-19 death in sub-Saharan Africa and the effects of HIV and tuberculosis on COVID-19 outcomes are unknown.METHODS: We conducted a population cohort study using linked data from adults attending public sector health facilities in the Western Cape, South Africa. We used Cox-proportional hazards models adjusted for age, sex, location and comorbidities to examine the association between HIV, tuberculosis and COVID-19 death from 1 March-9 June 2020 among (i) public sector "active patients" (≥1 visit in the 3 years before March 2020), (ii) laboratory-diagnosed COVID-19 cases and (iii) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19 comparing HIV positive vs. negative adults using modelled population estimates.
    RESULTS: Among 3,460,932 patients (16% HIV positive), 22,308 were diagnosed with COVID-19, of whom 625 died. COVID-19 death was associated with male sex, increasing age, diabetes, hypertension and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR] 2.14; 95% confidence interval [CI] 1.70-2.70), with similar risks across strata of viral load and immunosuppression. Current and previous tuberculosis were associated with COVID-19 death (aHR [95%CI] 2.70 [1.81-4.04] and 1.51 [1.18-1.93] respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95%CI 1.96-2.86); population attributable fraction 8.5% (95%CI 6.1-11.1).
    CONCLUSION: While our findings may over-estimate HIV- and tuberculosis-associated COVID-19 mortality risks due to residual confounding, both HIV and current tuberculosis were independently associated with increased COVID-19 mortality. The associations between age, sex and other comorbidities and COVID-19 mortality were similar to other settings.
    Keywords:  COVID-19; HIV; antiretroviral; sub-Saharan Africa; tuberculosis
    DOI:  https://doi.org/10.1093/cid/ciaa1198
  5. Diabetol Metab Syndr. 2020 ;12 75
    de Almeida-Pititto B, Dualib PM, Zajdenverg L, Dantas JR, de Souza FD, Rodacki M, Bertoluci MC, .
      Background: The aim of this study is to evaluate the impact of diabetes, hypertension, cardiovascular disease and the use of angiotensin converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB) with severity (invasive mechanical ventilation or intensive care unit admission or O2 saturation < 90%) and mortality of COVID-19 cases.Methods: Systematic review of the PubMed, Cochrane Library and SciELO databases was performed to identify relevant articles published from December 2019 to 6th May 2020. Forty articles were included involving 18.012 COVID-19 patients.
    Results: The random-effect meta-analysis showed that diabetes mellitus and hypertension were moderately associated respectively with severity and mortality for COVID-19: Diabetes [OR 2.35 95% CI 1.80-3.06 and OR 2.50 95% CI 1.74-3.59] Hypertension: [OR 2.98 95% CI 2.37-3.75 and OR 2.88 (2.22-3.74)]. Cardiovascular disease was strongly associated with both severity and mortality, respectively [OR 4.02 (2.76-5.86) and OR 6.34 (3.71-10.84)]. On the contrary, the use of ACEI/ARB, was not associate with severity of COVID-19.
    Conclusion: In conclusion, diabetes, hypertension and especially cardiovascular disease, are important risk factors for severity and mortality in COVID-19 infected people and are targets that must be intensively addressed in the management of this infection.
    Keywords:  COVID-19; Cardiovascular disease; Diabetes; Hypertension; Mortality; SARS-CoV-2; Severity
    DOI:  https://doi.org/10.1186/s13098-020-00586-4
  6. J Endocr Soc. 2020 Sep 01. 4(9): bvaa102
    Barrera FJ, Shekhar S, Wurth R, Moreno-Pena PJ, Ponce OJ, Hajdenberg M, Alvarez-Villalobos NA, Hall JE, Schiffrin EL, Eisenhofer G, Porter F, Brito JP, Bornstein SR, Stratakis CA, González-González JG, Rodíguez-Gutiérrez R, Hannah-Shmouni F.
      Coronavirus disease 2019 (Covid-19) has affected millions of people and may disproportionately affect those with hypertension and diabetes. Because of inadequate methods in published systematic reviews, the prevalence of diabetes and hypertension and associated risks of poor outcomes in Covid-19 patients are unknown. We searched databases from December 1, 2019, to April 6, 2020, and selected observational peer-reviewed studies in English of patients with Covid-19. Independent reviewers extracted data on study participants, interventions, and outcomes and assessed risk of bias, and the certainty of evidence. We included 65 (15 794 participants) observational studies at moderate to high risk of bias. Overall prevalence of diabetes and hypertension was 12% (95% confidence interval [CI], 10-15; n = 12 870; I 2: 89%), and 17% (95% CI, 13-22; n = 12 709; I 2: 95%), respectively. In severe Covid-19, the prevalence of diabetes and hypertension were 18% (95% CI, 16-20; n = 1099; I 2: 0%) and 32% (95% CI, 16-54; n = 1078; I 2: 63%), respectively. Unadjusted relative risk for intensive care unit admission and mortality were 1.96 (95% CI, 1.19-3.22; n = 8890; I 2: 80%; P = .008) and 2.78 (95% CI, 1.39-5.58; n = 2058; I 2: 75%; P = .0004) for diabetics; and 2.95 (95% CI, 2.18-3.99; n = 1737; I 2: 0%; P < .001) and 2.39 (95% CI, 1.54-3.73; n = 3107; I 2: 66%; P < .001) for hypertensives. Neither diabetes (1.50; 95% CI, 0.90-2.50; n = 1991; I 2: 74%; P = .119) nor hypertension (1.48; 95% CI, 0.99-2.23; n = 2023; I 2: 69%; P = .058) was associated with severe Covid-19. In conclusion, the risk of intensive care unit admission and mortality for patients with diabetes or hypertension who developed Covid-19 is increased compared with those without these comorbidities.PROSPERO registration number: CRD42020176582.
    Keywords:  Covid-19; SARS-CoV-2; diabetes mellitus; endocrinology; hypertension
    DOI:  https://doi.org/10.1210/jendso/bvaa102
  7. BMJ Open Respir Res. 2020 Sep;pii: e000644. [Epub ahead of print]7(1):
    Sapey E, Gallier S, Mainey C, Nightingale P, McNulty D, Crothers H, Evison F, Reeves K, Pagano D, Denniston AK, Nirantharakumar K, Diggle P, Ball S, .
      BACKGROUND: Studies suggest that certain black and Asian minority ethnic groups experience poorer outcomes from COVID-19, but these studies have not provided insight into potential reasons for this. We hypothesised that outcomes would be poorer for those of South Asian ethnicity hospitalised from a confirmed SARS-CoV-2 infection, once confounding factors, health-seeking behaviours and community demographics were considered, and that this might reflect a more aggressive disease course in these patients.METHODS: Patients with confirmed SARS-CoV-2 infection requiring admission to University Hospitals Birmingham NHS Foundation Trust (UHB) in Birmingham, UK between 10 March 2020 and 17 April 2020 were included. Standardised admission ratio (SAR) and standardised mortality ratio (SMR) were calculated using observed COVID-19 admissions/deaths and 2011 census data. Adjusted HR for mortality was estimated using Cox proportional hazard model adjusting and propensity score matching.
    RESULTS: All patients admitted to UHB with COVID-19 during the study period were included (2217 in total). 58% were male, 69.5% were white and the majority (80.2%) had comorbidities. 18.5% were of South Asian ethnicity, and these patients were more likely to be younger and have no comorbidities, but twice the prevalence of diabetes than white patients. SAR and SMR suggested more admissions and deaths in South Asian patients than would be predicted and they were more likely to present with severe disease despite no delay in presentation since symptom onset. South Asian ethnicity was associated with an increased risk of death, both by Cox regression (HR 1.4, 95% CI 1.2 to 1.8), after adjusting for age, sex, deprivation and comorbidities, and by propensity score matching, matching for the same factors but categorising ethnicity into South Asian or not (HR 1.3, 95% CI 1.0 to 1.6).
    CONCLUSIONS: Those of South Asian ethnicity appear at risk of worse COVID-19 outcomes. Further studies need to establish the underlying mechanistic pathways.
    Keywords:  clinical epidemiology; respiratory infection; viral infection
    DOI:  https://doi.org/10.1136/bmjresp-2020-000644
  8. Diabetes Metab Syndr. 2020 Aug 20. pii: S1871-4021(20)30317-9. [Epub ahead of print]14(6): 1595-1602
    Hussain S, Baxi H, Chand Jamali M, Nisar N, Hussain MS.
      BACKGROUND & AIMS: Coronavirus disease 2019 (COVID-19) spreads rapidly and within no time, it has been declared a pandemic by the World Health Organization. Evidence suggests diabetes to be a risk factor for the progression and poor prognosis of COVID-19. Therefore, we aimed to understand the pooled prevalence of diabetes in patients infected with COVID-19. We also aimed to compute the risk of mortality and ICU admissions in COVID-19 patients with and without diabetes.METHODS: A comprehensive literature search was performed in PubMed to identify the articles reporting the diabetes prevalence and risk of mortality or ICU admission in COVID-19 patients. The primary outcome was to compute the pooled prevalence of diabetes in COVID-19 patients. Secondary outcomes included risk of mortality and ICU admissions in COVID-19 patients with diabetes compared to patients without diabetes.
    RESULTS: This meta-analysis was based on a total of 23007 patients from 43 studies. The pooled prevalence of diabetes in patients infected with COVID-19 was found to be 15% (95% CI: 12%-18%), p = <0.0001. Mortality risk was found to be significantly higher in COVID-19 patients with diabetes as compared to COVID-19 patients without diabetes with a pooled risk ratio of 1.61 (95% CI: 1.16-2.25%), p = 0.005. Likewise, risk of ICU admission rate was significantly higher in COVID-19 patients with diabetes as compared to COVID-19 patients without diabetes with a pooled risk ratio of 1.88 (1.20%-2.93%), p = 0.006.
    CONCLUSION: This meta-analysis found a high prevalence of diabetes and higher mortality and ICU admission risk in COVID-19 patients with diabetes.
    Keywords:  COVID-19; Diabetes; ICU admission; Meta-analysis; Mortality; Prevalence
    DOI:  https://doi.org/10.1016/j.dsx.2020.08.014
  9. J Gerontol A Biol Sci Med Sci. 2020 Sep 01. pii: glaa219. [Epub ahead of print]
    Esme M, Koca M, Dikmeer A, Balci C, Ata N, Dogu BB, Cankurtaran M, Yilmaz M, Celik O, Unal GG, Ulgu MM, Birinci S.
      BACKGROUND: A novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) occurred in China in December 2019 and has spread globally. In this study we aimed to describe the clinical characteristics and outcomes of hospitalized older adults with coronavirus disease 2019 (COVID-19) in Turkey.METHODS: We retrospectively analyzed the clinical data of hospitalized patients aged ≥ 60 years with confirmed COVID-19 from March 11, 2020, to May 27, 2020 using nationwide health database.
    RESULTS: In this nationwide cohort, a total of 16942 hospitalized older adults with COVID-19 were enrolled, of whom 8635 (51%) were women. Mean age was 71.2 ± 8.5 years, ranging from 60 to 113 years. Mortality rate before and after curfew was statistically different (32.2% vs 17.9%; p & 0.001, respectively). Through multivariate analysis of the causes of death in older patients, we found that male gender, diabetes mellitus, heart failure, chronic kidney disease, dementia, cancer, admission to intensive care unit, computed tomography finding compatible with COVID-19 were all significantly associated with mortality in entire cohort. In addition to abovementioned risk factors, in patients aged between 60-79 years, coronary artery disease, oxygen support need, total number of drugs, and cerebrovascular disease during hospitalization, and in patients 80 years of age and older acute coronary syndrome during hospitalization were also associated with increased risk of mortality.
    CONCLUSIONS: In addition to the results of previous studies with smaller sample size, our results confirmed the age-related relationship between specific comorbidities and COVID-19 related mortality.
    Keywords:  COVID-19; Infection; Nationwide; Risk Factors
    DOI:  https://doi.org/10.1093/gerona/glaa219
  10. Obesity (Silver Spring). 2020 Sep 04.
    Fresán U, Guevara M, Elía F, Albéniz E, Burgui C, Castilla J, .
      OBJECTIVES: To analyze the association between morbid obesity and COVID-19 hospitalization and severe disease.METHODS: We evaluated the incidence of hospitalization for laboratory-confirmed COVID-19 in a prospective population-based cohort of 433,995 persons aged 25-79 years in Spain during March and April 2020. Persons with and without morbid obesity were compared using Poisson regression to estimate the adjusted relative risk (aRR) of morbid obesity for COVID-19 hospitalization and for severe disease (intensive care unit admission or death). Differences in the effect by age, sex and chronic conditions were evaluated.
    RESULTS: Individuals with morbid obesity had higher risk of hospitalization (aRR=2.20; 95% confidence interval (CI) 1.66-2.93) and severe COVID-19 (aRR=2.30; 95%CI 1.20-4.40). In people younger than 50 years, these effects were more pronounced (aRR=5.02, 95%CI 3.19-7.90; and aRR=13.80, 95%CI 3.11-61.17, respectively), while no significant effects were observed in those aged 65-79 years (aRR=1.22, 95%CI 0.70-2.12; and aRR=1.42, 95%CI 0.52-3.88, respectively). Sex and chronic conditions did not modify the effect of morbid in any of the outcomes.
    CONCLUSIONS: Morbid obesity is a relevant risk factor for COVID-19 hospitalization and severity in young adults, of a similar magnitude as aging. Tackling current obesity pandemic could alleviate impact of chronic and infectious diseases.
    Keywords:  COVID-19 hospitalization; COVID-19 mortality; COVID-19 risk factor; SARS-CoV-2; morbid obesity
    DOI:  https://doi.org/10.1002/oby.23029