Obesidade e COVID-19: estudo de base populacional da mortalidade por SRAG no Brasil

Abstract

Obesity in patients with COVID-19 has been associated with a higher risk of outcomes such as intensive care unit (ICU) admission, need for mechanical ventilation (MV), and in-hospital death. However, some gaps remain, such as the relationship between age and obesity in COVID-19 deaths and the magnitude of protection conferred by the vaccine on obese people. The study's objectives were thus as follows: i) to assess the effect of obesity on the risk of death and whether this effect changes with age; and ii) to assess the effect of the number of doses (one, two, or three) of the SARS-CoV-2 vaccine on the outcomes hospital death, ICU admission, need for MV, and length of stay in obese and non-obese patients hospitalized for COVID-19. The study population consisted of 2,429,183 adults (≥18 years old), hospitalized for SARI between March 2020 and September 2022, from the public access database (SIVEP-Gripe). To investigate the risk of admission to the ICU, the need for MV, and death, a logistic regression model was used, and when the outcome was length of stay (days), a generalized linear model with a gamma distribution and log link function was chosen. The mean age was 60 years, 56.4% men, 19.8% were obese, hospital mortality was 30.7%, and 51.2% received at least one dose of the vaccine against SARS-CoV-2. In the adjusted logistic model, the risk of death in the obese vaccinated with at least one dose was 37% higher than in the non-obese, whereas the unvaccinated obese had a 67% higher risk of death when compared to the non-vaccinated non-obese. Both in vaccinated and unvaccinated individuals, the interaction term between obesity and age (categorical) variables was significant (p<0.05) only for obese individuals aged over 90 years, with the comparison group being non-obese individuals aged 18 to 40 years. Two and three doses of the vaccine reduced the risk of death and need for MV in obese and non-obese individuals in all age groups, with those aged less than or equal to 60 years being more protected. Among individuals aged up to 60 years who took two doses, the obese were more protected when compared to the non-obese (in the age groups 18-40 years, 41-50 years, and 51-60 years, the Odds Ratio (OR) for the obese were, respectively: OR = 0.32 (CI 95%: 0.23-0.43), OR = 0.29 (0.22-0.38) and OR = 0.30 (0.24 -0.38); while for the non-obese, they were, respectively: OR = 0.53 (0.45-0.64), OR= 0.48 (0.41-0.56) and OR= 0.49 (0.44-0.55). Obese patients had a 12% longer length of stay than non-obese patients (p<0.001). No difference was observed in the length of stay according to vaccination status. These findings may contribute to an even more assertive vaccination campaign.