Diabetes, hypertension, body mass index, smoking and COVID-19-related mortality: a systematic review and meta-analysis of observational studies.
Details
State: Public
Version: Final published version
License: CC BY-NC 4.0
Serval ID
serval:BIB_8302298890BB
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Diabetes, hypertension, body mass index, smoking and COVID-19-related mortality: a systematic review and meta-analysis of observational studies.
Journal
BMJ open
ISSN
2044-6055 (Electronic)
ISSN-L
2044-6055
Publication state
Published
Issued date
25/10/2021
Peer-reviewed
Oui
Volume
11
Number
10
Pages
e052777
Language
english
Notes
Publication types: Journal Article ; Meta-Analysis ; Systematic Review
Publication Status: epublish
Publication Status: epublish
Abstract
We conducted a systematic literature review and meta-analysis of observational studies to investigate the association between diabetes, hypertension, body mass index (BMI) or smoking with the risk of death in patients with COVID-19 and to estimate the proportion of deaths attributable to these conditions.
Relevant observational studies were identified by searches in the PubMed, Cochrane library and Embase databases through 14 November 2020. Random-effects models were used to estimate summary relative risks (SRRs) and 95% CIs. Certainty of evidence was assessed using the Cochrane methods and the Grading of Recommendations, Assessment, Development and Evaluations framework.
A total of 186 studies representing 210 447 deaths among 1 304 587 patients with COVID-19 were included in this analysis. The SRR for death in patients with COVID-19 was 1.54 (95% CI 1.44 to 1.64, I <sup>2</sup> =92%, n=145, low certainty) for diabetes and 1.42 (95% CI 1.30 to 1.54, I <sup>2</sup> =90%, n=127, low certainty) for hypertension compared with patients without each of these comorbidities. Regarding obesity, the SSR was 1.45 (95% CI 1.31 to 1.61, I <sup>2</sup> =91%, n=54, high certainty) for patients with BMI ≥30 kg/m <sup>2</sup> compared with those with BMI <30 kg/m <sup>2</sup> and 1.12 (95% CI 1.07 to 1.17, I <sup>2</sup> =68%, n=25) per 5 kg/m <sup>2</sup> increase in BMI. There was evidence of a J-shaped non-linear dose-response relationship between BMI and mortality from COVID-19, with the nadir of the curve at a BMI of around 22-24, and a 1.5-2-fold increase in COVID-19 mortality with extreme obesity (BMI of 40-45). The SRR was 1.28 (95% CI 1.17 to 1.40, I <sup>2</sup> =74%, n=28, low certainty) for ever, 1.29 (95% CI 1.03 to 1.62, I <sup>2</sup> =84%, n=19) for current and 1.25 (95% CI 1.11 to 1.42, I <sup>2</sup> =75%, n=14) for former smokers compared with never smokers. The absolute risk of COVID-19 death was increased by 14%, 11%, 12% and 7% for diabetes, hypertension, obesity and smoking, respectively. The proportion of deaths attributable to diabetes, hypertension, obesity and smoking was 8%, 7%, 11% and 2%, respectively.
Our findings suggest that diabetes, hypertension, obesity and smoking were associated with higher COVID-19 mortality, contributing to nearly 30% of COVID-19 deaths.
CRD42020218115.
Relevant observational studies were identified by searches in the PubMed, Cochrane library and Embase databases through 14 November 2020. Random-effects models were used to estimate summary relative risks (SRRs) and 95% CIs. Certainty of evidence was assessed using the Cochrane methods and the Grading of Recommendations, Assessment, Development and Evaluations framework.
A total of 186 studies representing 210 447 deaths among 1 304 587 patients with COVID-19 were included in this analysis. The SRR for death in patients with COVID-19 was 1.54 (95% CI 1.44 to 1.64, I <sup>2</sup> =92%, n=145, low certainty) for diabetes and 1.42 (95% CI 1.30 to 1.54, I <sup>2</sup> =90%, n=127, low certainty) for hypertension compared with patients without each of these comorbidities. Regarding obesity, the SSR was 1.45 (95% CI 1.31 to 1.61, I <sup>2</sup> =91%, n=54, high certainty) for patients with BMI ≥30 kg/m <sup>2</sup> compared with those with BMI <30 kg/m <sup>2</sup> and 1.12 (95% CI 1.07 to 1.17, I <sup>2</sup> =68%, n=25) per 5 kg/m <sup>2</sup> increase in BMI. There was evidence of a J-shaped non-linear dose-response relationship between BMI and mortality from COVID-19, with the nadir of the curve at a BMI of around 22-24, and a 1.5-2-fold increase in COVID-19 mortality with extreme obesity (BMI of 40-45). The SRR was 1.28 (95% CI 1.17 to 1.40, I <sup>2</sup> =74%, n=28, low certainty) for ever, 1.29 (95% CI 1.03 to 1.62, I <sup>2</sup> =84%, n=19) for current and 1.25 (95% CI 1.11 to 1.42, I <sup>2</sup> =75%, n=14) for former smokers compared with never smokers. The absolute risk of COVID-19 death was increased by 14%, 11%, 12% and 7% for diabetes, hypertension, obesity and smoking, respectively. The proportion of deaths attributable to diabetes, hypertension, obesity and smoking was 8%, 7%, 11% and 2%, respectively.
Our findings suggest that diabetes, hypertension, obesity and smoking were associated with higher COVID-19 mortality, contributing to nearly 30% of COVID-19 deaths.
CRD42020218115.
Keywords
Body Mass Index, COVID-19, Diabetes Mellitus, Humans, Hypertension, SARS-CoV-2, Smoking, epidemiology, general diabetes, hypertension
Pubmed
Web of science
Open Access
Yes
Create date
09/11/2021 11:28
Last modification date
12/01/2022 7:11
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