Why should obese youth be prioritized in COVID-19 vaccination programs? A nationwide retrospective study.

BACKGROUND: The dominant effect of age on COVID-19 mortality obscures the impact of other risk factors. Although the elderly is at a greater risk of severe disease and death due to COVID-19, the interaction of obesity and age was not carefully assessed. This analysis is especially critical for prioritizing groups to receive COVID-19 vaccination. METHODS: Starting with 1,120,767 unvaccinated individuals registered in a Brazilian surveillance system, we selected 313,898 hospitalized COVID-19 patients aged 20 to 89 who had a BMI ≥ 25 kg/m2 and cardiovascular diseases (CVD) or diabetes, as well as individuals with no risk factors associated with severe COVID-19. Patient data were stratified by age, obesity, BMI, and comorbidities, and subsequently, subjected to crude and adjusted odds ratio, hazard ratio, and Kaplan-Meier curves. Disease outcomes were invasive and non-invasive ventilatory support, intensive care unit (ICU) admission, and death. FINDINGS: Obesity alone is a risk factor for in-hospital mortality and is more significant than cardiovascular disease and diabetes. Furthermore, obesity, cardiovascular disease, and diabetes increase the risk of severity and death by COVID-19 more significantly in young adults than in the elderly. When categorizing patients by obesity classes, the severity of obesity was found to be associated with a higher risk of admission to the ICU and death from COVID-19 than the non-obese young adults or elderly population. INTERPRETATION: Our findings highlight the increased risk of severe COVID-19 on the Brazilian obese youth. As SARS-CoV-2 may become a recurrent seasonal infection, future vaccination campaigns against COVID-19 should prioritize obese young individuals. FUNDINGS: This work was supported by the Brazilian National Council for Scientific and Technological Development (grant number 313662/2017-7 and 307356/2017-5; the São Paulo Research Foundation (grant numbers 2018/14933-2); and CAPES.

Fatores associados ao baixo peso ao nascimento entre adolescentes no Sudeste do Brasil / Factors associated with low birth weight among adolescents in the Brazil Southeast region

OBJETIVOS: Conhecer a prevalência e alguns fatores associados ao baixo peso ao nascer entre gestantes adolescentes. MÉTODOS: Estudo de corte transversal, realizado entre outubro de 1994 a dezembro de 2009, com os partos ocorridos em uma maternidade de Campinas, utilizando informações coletadas em uma Ficha Obstétrica Informatizada. Foram selecionados os casos de partos entre adolescentes e, posteriormente, separados em dois grupos com e sem baixo peso ao nascer. Foram calculados o risco relativo e o intervalo de confiança (IC) de 95 por cento para as variáveis independentes (fatores de risco), e calculou-se o teste do Χ2 para comparação dos resultados perinatais. Assumiu-se nível de significância de 5 por cento. RESULTADOS: No período ocorreram 24.000 partos no Centro de Atenção à Saúde da Mulher (CAISM), com 2.404 em 2.357 adolescentes (10,02 por cento), sendo a frequência de baixo peso ao nascer de 15,1 por cento. A gestação neste grupo foi recorrente em 294 (8,2 por cento). A idade menor que 15 anos, anemia, tabagismo e hipertensão não se associaram ao baixo peso ao nascer. O antecedente de aborto e a associação com lúpus eritematoso sistêmico elevaram o risco de baixo peso ao nascer. A necessidade de cesariana e o Apgar menor que sete também foram mais prevalentes entre as adolescentes com baixo peso ao nascer, e 85 por cento das adolescentes realizaram menos de seis consultas durante o pré-natal. CONCLUSÕES: A prevalência de baixo peso ao nascer é maior entre as adolescentes do que na população geral. Também chamou a atenção o grande número de adolescentes com menos de seis consultas durante o pré-natal. O antecedente de aborto e a presença de lúpus eritematoso sistêmico foram fatores de risco para ocorrência de baixo peso ao nascer em gestantes adolescentes.

PURPOSES: To determine the rate of low birth weight and some of the risk factors associated with this event among adolescents. METHODS: A cross-sectional study conducted between October 1994 and December 2009 at a maternity in Campinas, in Brazil, using information generated from the computerized obstetric form. After selection of adolescents who delivered at this hospital, two groups were created, with and without low birth weight, respectively. Relative risk and 95 percent confidence interval for all independent variables (risk factors) and the Χ2 test for some perinatal results were performed. The level of significance was set at 5 percent. RESULTS: During the study period, 24,000 births occurred at CAISM. Of these, 2,404 occurred among 2,357 teenagers (10.02 percent) and the frequency of low birth weight was 15.1 percent. Adolescent pregnancy recurred in 294 (8.2 percent). Age less than 15 years-old, anemia, smoking, and hypertension were not significantly associated with low birth weight. Antecedent of miscarriage and association with systemic lupus erythematosus increased the risk of low birth weight. Cesarean section and an Apgar score below seven were more prevalent among adolescents with low birth weight, and 85 percent of all adolescents had less than six prenatal visits. CONCLUSIONS: The prevalence of low birth weight is higher among adolescents than among adult women, and there was a large number of adolescents with less than six prenatal visits . The antecedent of miscarriage and the presence of systemic lupus erythematosus were risk factors associated with the occurrence of low birth weight among adolescents.

[Factors associated with low birth weight among adolescents in the Brazil Southeast region]. / Fatores associados ao baixo peso ao nascimento entre adolescentes no Sudeste do Brasil.

PURPOSES: To determine the rate of low birth weight and some of the risk factors associated with this event among adolescents. METHODS: A cross-sectional study conducted between October 1994 and December 2009 at a maternity in Campinas, in Brazil, using information generated from the computerized obstetric form. After selection of adolescents who delivered at this hospital, two groups were created, with and without low birth weight, respectively. Relative risk and 95% confidence interval for all independent variables (risk factors) and the Χ2 test for some perinatal results were performed. The level of significance was set at 5%. RESULTS: During the study period, 24,000 births occurred at CAISM. Of these, 2,404 occurred among 2,357 teenagers (10.02%) and the frequency of low birth weight was 15.1%. Adolescent pregnancy recurred in 294 (8.2%). Age less than 15 years-old, anemia, smoking, and hypertension were not significantly associated with low birth weight. Antecedent of miscarriage and association with systemic lupus erythematosus increased the risk of low birth weight. Cesarean section and an Apgar score below seven were more prevalent among adolescents with low birth weight, and 85% of all adolescents had less than six prenatal visits. CONCLUSIONS: The prevalence of low birth weight is higher among adolescents than among adult women, and there was a large number of adolescents with less than six prenatal visits. The antecedent of miscarriage and the presence of systemic lupus erythematosus were risk factors associated with the occurrence of low birth weight among adolescents.