Prevalence of COVID-19 and long COVID - Results from the 2022 Behavioral Risk Factor Surveillance System, 50 states. (preprint)

Recent MMWR results estimate long COVID prevalence at 6.0% in June 2023, while the percentage of those with COVID reporting long COVID was 11.0%. The 2022 Behavioral Risk Factor Surveillance System addressed COVID (positive test) and long COVID (symptoms lasting [≥]3 months) in a population-based sample from each state and DC. Results for 385,617 adults indicated 34.4% had ever had COVID, 21.9% of whom reported long COVID, representing 7.4% of all adults. State rates ranged from 25.4% - 40.8% for COVID and 4.1%-11.1% for long COVID. Groups with high rates for both included women, younger adults, those with children in the household, plus those reporting obesity, asthma, chronic obstructive pulmonary disease (COPD), diabetes, or cardiovascular disease (CVD). Highest adjusted odds ratios for COVID were 2.34 (95% CI 2.20-2.49) for age 18-24 years vs. age 65+ while for long COVID it was 2.81 (2.53-3.13) for 3+ of the 5 conditions. Most frequently reported problems for those with long COVID were fatigue (26.0%), shortness of breath (18.8%), loss of taste or smell (17.2%), and memory problems (9.9%). Results show the need for state-based data and suggest a focus on younger adults is needed to address COVID and long COVID.

Global association of obesity and COVID-19 death rates (preprint)

Importance: COVID-19 was responsible for an enormous global death toll with large variation among countries. Objective: To examine the possible impact of obesity on COVID-19 death rates. Design: Measure associations between obesity rates in 2016 and COVID-19 deaths/million population through 2/25/2021, across countries. Setting: Global Participants: 167 countries for which obesity and death data were available, grouped by population size, with multiples of 10 countries in each of 8 groups plus a group including all 57 countries with obesity rates <15%. Outcome and measures: Using Excel, COVID-19 deaths/million were regressed on the obesity rate for each country, based on obesity being a key factor in COVID hospitalizations and deaths. Using the least squares formula for the best fit for each model, R2, components of the formula, and the percentage of world population represented, were recorded for each group. Results: Obesity rates ranged from 2.1% to 37.9% and death rates ranged from 0.4/million to 1,892/million for groups representing up to 91% of global population. Results for the 8 population groups had R2 from 0.30 to 0.90 with slopes of the fitted line ranging from 27.9-51.0. Countries with obesity rates <15% had consistently low death rates ([≤]233/million), R2 of 0.003 and slope of the line=1.01. Conclusions: For most countries about one-third of the difference in COVID death rates was due to obesity while in countries with obesity <15%, consistently low death rates were not associated with obesity. Reduced obesity rates could potentially have lowered the COVID death toll.

Reducing COVID-19 hospitalization risk through behavior change (preprint)

Our objective was to determine strategies that could potentially reduce the risk of hospitalizations from COVID-19 due to underlying conditions. We used data (N=444,649) from the 2017 Behavioral Risk Factor Surveillance System to identify potentially modifiable risk factors associated with reporting any of the underlying conditions (cardiovascular disease, asthma, chronic obstructive pulmonary disease, diabetes, hypertension or obesity) found to increase risk of US hospitalizations for COVID-19. Risk factors included lifetime smoking, sedentary lifestyle, and inadequate fruit and vegetable consumption. Multiple logistic regression in Stata produced adjusted odds ratios (AORs) used to estimate population attributable-risk (PAR) in Excel. PARs for the 3 risk factors ranged from 12.4% for inactivity to 15.6% for diet for a combined PAR of 36.3%, implying that total elimination of these 3 risk factors could potentially reduce underlying conditions as much as 36%. This suggests that reducing COVID-19 hospitalizations might be a measurable and feasible US goal for the coronavirus pandemic. The simple lifestyle changes of increasing physical activity and fruit and vegetable consumption could reduce obesity, a key underlying condition and risk factor for 4 others. Reducing obesity and inactivity may also boost immunity. With uncertainly around how long the pandemic might last, other proposed strategies include wearing face masks when social distancing is not feasible, and addressing the special issues for nursing home residents. Such actions have the potential to lessen the impact of COVID-19 in the short term along with providing long term health benefits regarding chronic conditions.

Updated estimates of comorbidities associated with risk for COVID-19 complications based on US data (preprint)

We updated previous estimates (wwwnc.cdc.gov/eid/article/26/8/20-0679_article) of adults with any underlying condition increasing risk of complications from COVID-19 using recent US hospitalization data instead of mortality data from China. This substitutes obesity for cancer in the definition and increased the percentage of adults reporting more than 1 condition to 56.0% (95% CI 55.7-56.4). When controlled for all measures listed, factors increasing odds of reporting any of the underlying conditions include being male, older, African American, American Indian, household income

Population based estimates of comorbidities affecting risk for complications from COVID-19 in the US (preprint)

We used 2017 Behavioral Risk Factor Surveillance System (BRFSS) data (N=444,649) to estimate the proportion of US adults who report comorbidities that suggest heightened risk of complications from COVID-19. Co-morbidities included cardiovascular disease, chronic obstructive pulmonary disease (COPD), diabetes, asthma, hypertension, and/or cancer other than skin, based on data from China. Overall 45.4% (95% CI 45.1-45.7) of adults reported any of the 6 comorbidities, increasing from 19.8% (19.1-20.4) for ages 18-29 years to 80.7% (79.5-81.8) for ages 80+ years. State rates ranged from 37.3% (36.2-38.5) in Utah to 58.7% (57.0-60.4) in West Virginia. Rates also varied by race/ethnicity, health insurance status, and employment. Excluded were residents of nursing homes or assisted living facilities. Although almost certainly an underestimate of all adults at risk due to these exclusions, these results should help in estimating healthcare needs for adults with COVID-19 complications living in the community.