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1.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-320595

ABSTRACT

Background: Patients who smoke and with preexisting comorbidities have a greater risk of developing severe coronavirus disease 2019 (COVID-19) and have a higher mortality rate. However, the number of deaths attributable to diabetes, hypertension, obesity, or smoking have never been estimated. 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.Methods: Relevant observational studies were identified by searches in the PubMed and Embase databases through October 29, 2020. Random-effects models were used to estimate summary relative risks (SRRs) and 95% confidence intervals (CIs). We further estimated the proportion of deaths attributable to these conditions. Certainty of evidence was assessed using the Cochrane methods and the GRADE framework. This study is registered with PROSPERO, CRD42020218115.Findings: 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 COVID-19 patients was 1.54 (95% CI=1.44-1.64, I2=92%, n=145, low certainty) for diabetes and 1.42 (95% CI=1.30-1.54, I2=90%, n=127, low certainty) for hypertension compared to patients without each of these comorbidities. Regarding obesity, the SSR was 1.45 (95% CI=1.31-1.61, I2=91%, n=54, high certainty) for patients with BMI ≥30kg/m2 compared to those with BMI <30kg/m2 and 1.12 (95% CI=1.07-1.17, I2=68%, n=25) per 5 kg/m2 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 40-50). The SRR was 1.28 (95% CI=1.29-1.50, I2=74.0, n=28, low certainty) for ever, 1.29 (95% CI=1.03-1.62, I2=84%, n=19) for current and 1.26 (95% CI=1.11-1.42, I2=84%, n=14) for former smokers compared to never smokers. The proportion of deaths attributable to diabetes, hypertension, obesity, and smoking was 8%, 7%, 11%, and 2%, respectively.Interpretation: Our findings suggest that diabetes, hypertension, obesity and smoking are major contributors to COVID-19 mortality accounting for nearly 30% of COVID-19 deaths.Funding Statement: There was no funding source for this study.Declaration of Interests: We declare no competing interests.

2.
BMJ Open ; 11(10): e052777, 2021 10 25.
Article in English | MEDLINE | ID: covidwho-1484033

ABSTRACT

OBJECTIVES: 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. METHODS: 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. RESULTS: 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, I2=92%, n=145, low certainty) for diabetes and 1.42 (95% CI 1.30 to 1.54, I2=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, I2=91%, n=54, high certainty) for patients with BMI ≥30 kg/m2 compared with those with BMI <30 kg/m2 and 1.12 (95% CI 1.07 to 1.17, I2=68%, n=25) per 5 kg/m2 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, I2=74%, n=28, low certainty) for ever, 1.29 (95% CI 1.03 to 1.62, I2=84%, n=19) for current and 1.25 (95% CI 1.11 to 1.42, I2=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. CONCLUSION: Our findings suggest that diabetes, hypertension, obesity and smoking were associated with higher COVID-19 mortality, contributing to nearly 30% of COVID-19 deaths. TRIAL REGISTRATION NUMBER: CRD42020218115.


Subject(s)
COVID-19 , Diabetes Mellitus , Hypertension , Body Mass Index , Humans , SARS-CoV-2 , Smoking
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