Study: Two-thirds of COVID-19 Hospitalizations Attributable to 4 Major Cardiometabolic Conditions

A new modeling study estimates that 64% of US COVID-19 hospitalizations were attributable to at least 1 of 4 pre-existing cardiometabolic conditions.

A new modeling study based on national data found that a majority of adult coronavirus disease 2019 (COVID-19) hospitalizations in the US are attributable to at least 1 of 4 pre-existing cardiometabolic conditions: obesity, hypertension, diabetes, and heart failure, in that order.

Published February 25, 2021 in the Journal of the American Heart Association, the study used a mathematical simulation to estimate the number and proportion of US COVID-19 hospitalizations that could have been prevented if Americans did not suffer from one of the 4 major cardiometabolic conditions.

Researchers chose to examine obesity, hypertension, diabetes, and heart failure based on previous research showing each is an independent risk factor for severe outcomes, including hospitalization, among COVID-19 patients.

“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 lead author Dariush Mozaffarian, MD, MPH, DrPH, dean, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, in a university press release.

Mozaffarian and colleagues from the Friedman School estimated that, among the 906 849 total COVID-19 hospitalizations that occurred in US adults as of November 18, 2020:

  • 30% (274 322) were attributable to obesity;
  • 26% (237 738) were attributable to hypertension;
  • 21% (185 678) were attributable to diabetes; and
  • 12% (106 139) were attributable to heart failure.

When numbers for all 4 conditions were combined, 64% (575 419) of COVID-19 hospitalizations might have been prevented. When combined, a 10% decrease in national prevalence of each condition could prevent approximately 11% of all COVID-19 hospitalizations, according to the study model.

The model also estimated that age and race/ethnicity resulted in disparities in COVID-19 hospitalizations due to the 4 conditions. For example, approximately 8% of hospitalizations among adults aged <50 years were estimated to be due to diabetes vs 29% of hospitalizations among those aged ≥65 years. Obesity, however, was an exception as it had equally detrimental impact on COVID-19 hospitalizations across age groups.

Across all age groups, COVID-19 hospitalizations attributable to all 4 conditions were higher in Black adults vs White adults, and generally higher for diabetes and obesity in Hispanic adults vs White adults. For example, among adults aged ≥65 years, diabetes was estimated to cause approximately 25% of COVID-19 hospitalizations among White adults, vs about 32% among Black adults and 34% among Hispanic adults.

“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 to people with cardiometabolic conditions, particularly among groups most affected by health disparities,” said Mozaffarian in the same press release. “Policies aimed at reducing the prevalence of these four cardiometabolic conditions among Black and Hispanic Americans must be part of any state or national policy discussion aimed at reducing health disparities from COVID-19.”