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Diabetes, hypertension, body mass index, smoking and COVID-19-related mortality: a systematic review and meta-analysis of observational studies.
Mahamat-Saleh, Yahya; Fiolet, Thibault; Rebeaud, Mathieu Edouard; Mulot, Matthieu; Guihur, Anthony; El Fatouhi, Douae; Laouali, Nasser; Peiffer-Smadja, Nathan; Aune, Dagfinn; Severi, Gianluca.
  • Mahamat-Saleh Y; Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France Yahya.MAHAMAT-SALEH@gustaveroussy.fr.
  • Fiolet T; Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France.
  • Rebeaud ME; Department of Plant Molecular Biology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
  • Mulot M; Laboratory of Soil Biodiversity, Faculty of Science, University of Neuchatel, Neuchâtel, Switzerland.
  • Guihur A; Department of Plant Molecular Biology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
  • El Fatouhi D; Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France.
  • Laouali N; Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France.
  • Peiffer-Smadja N; Universite de Paris, IAME, INSERM, Paris, France.
  • Aune D; National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK.
  • Severi G; Infectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital, AP-HP, Paris, France.
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Diabetes Mellitus / COVID-19 / Hypertension Type of study: Prognostic study / Randomized controlled trials / Reviews / Systematic review Limits: Humans Language: English Journal: BMJ Open Year: 2021 Document Type: Article Affiliation country: Bmjopen-2021-052777

Full text: Available Collection: International databases Database: MEDLINE Main subject: Diabetes Mellitus / COVID-19 / Hypertension Type of study: Prognostic study / Randomized controlled trials / Reviews / Systematic review Limits: Humans Language: English Journal: BMJ Open Year: 2021 Document Type: Article Affiliation country: Bmjopen-2021-052777