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Most Severe COVID Cases Tied to Four Conditions

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Feb. 25, 2021 -- The majority of COVID-19 hospitalizations in the United States are attributable to four pre-existing conditions, a new study suggests.

The authors estimate that among the 906,849 total COVID-19 hospitalizations of U.S. adults as of November, 30% were related to obesity, 26% to high blood pressure, 21% to diabetes, and 12% to heart failure.

From the data, the investigators estimate that almost two thirds (63.5%) of the hospitalizations were due to these conditions and that those hospitalization might not have been needed if the patients did not have one of those conditions.

They estimate that a 10% reduction in these four conditions could have prevented 11.1% of COVID-19 hospitalizations.

The authors believe more should be done to promote healthy lifestyle measures to improve overall health and minimize the risk for severe COVID-19.

"It is a sad fact that this disease has been around for a whole year with millions dead and tens of millions hospitalized worldwide, and we haven't addressed one of the major ways of preventing such severe outcomes," senior author Dariush Mozaffarian, MD, is a cardiologist and dean of the School of Nutrition Science and Policy at Tufts University in Boston, told Medscape.

The study was published online Feb. 25 in the Journal of the American Heart Association.

For their study, the researchers used a mathematical simulation to estimate the number and proportion of national COVID-19 hospitalizations that could have been prevented had Americans not had one or more of the four major conditions.

The researchers used data from a study of factors associated with hospital admission among 5,279 COVID-19 patients 19 at a major health center in New York City.

Data from the CDC's COVID-NET system and from the COVID Tracking Project were used to estimate COVID-19 hospitalizations by population. The data on the four conditions came from the most recent National Health and Nutrition Examination Survey.

The model showed that age and race/ethnicity were associated with COVID-19 hospitalizations as a result of these four conditions. For example, about 8% of COVID-19 hospitalizations among adults younger than 50 were estimated to be due to diabetes, compared to about 29% of COVID-19 hospitalizations among those 65 and older. Obesity had an negative impact on COVID-19 hospitalizations across age groups.

At any age, COVID-19 hospitalizations attributable to all four conditions were higher in Black patients than in White patients and were generally higher for diabetes and obesity among Hispanic patients.

For example, for people 65 and older, diabetes was estimated to cause about 25% of COVID-19 hospitalizations among White patients, about 32% among Black patients, and about 34% among Hispanic patients.

When the four conditions were considered together, hospitalizations were highest for Black adults of all ages, followed by Hispanics. For example, among adults aged 18 to 49 years, the four conditions jointly were estimated to cause about 39% of COVID-19 hospitalizations among White people and 50% among Black people.

"National data show that Black and Hispanic Americans are suffering the worst outcomes from COVID-19. Our findings lend support to the need for prioritizing vaccine distribution, good nutrition, and other preventive measures," Mozaffarian said.

"Policies aimed at reducing the prevalence of these four … conditions among Black and Hispanic Americans must be part of any state or national policy discussion aimed at reducing health disparities from COVID-19," he said.

Mozaffarian pointed out that the study used an established modeling approach but that the results are estimates and do not prove cause and effect.

Still, Mozaffarian believes the results do reflect cause and effect.

"This is not just a respiratory virus. It causes widespread vascular inflammation, which is consistent with these cardiometabolic conditions. If these conditions weren't there, COVID would be less severe," he said.

COVID-19 is a fast pandemic on top of the slow pandemic of obesity and diabetes.

Mozaffarian stressed the need for the public to understand the importance of good nutrition. "This is the foundation to heath. Poor nutrition is the single biggest contributor to disease globally, and it is also contributing to COVID situation," he said. "COVID-19 is a fast pandemic on top of the slow pandemic of obesity and diabetes."

George L. Bakris, MD, professor of medicine and director of the American Heart Association Comprehensive Hypertension Center at the University of Chicago Medicine, said the data is consistent with observations that older people, especially those with diabetes, heart disease, and lung disease, are at higher risk for more severe \COVID-19.

But he said that on the basis of much research, high blood pressure alone, has not been implicated as a factor in the severity of COVID.

"The government has previously had campaigns encouraging exercise and weight loss, and all the programs available to help facilitate this have not helped. While people are aware of the risks, they have great difficulty changing behavior," Bakris added

The research was supported by the National Institutes of Health and the National Heart, Lung, and Blood Institute. Mozaffarian has received research funding from the Gates Foundation and the Rockefeller Foundation; personal fees from the Global Organization for EPA & DHA omega-3s (GOED), Barilla, Bunge, Indigo Agriculture, Motif FoodWorks, Amarin, the Cleveland Clinic Foundation, and America's Test Kitchen (modest), and Acasti Pharma and Danone (significant). He has participated on scientific advisory boards of startup companies focused on innovations for health, including Brightseed, Calibrate, DayTwo, Elysium Health, Filtricine, Foodome, HumanCo, and Tiny Organics (significant), and has received chapter royalties from UpToDate (modest), all outside the submitted work.

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