1. Obesity during the COVID-19 pandemic: both cause of high risk and potential effect of lockdown? A population-based electronic health record study.
- Author
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Katsoulis, M., Pasea, L., Lai, A.G., Dobson, R.J.B., Denaxas, S., Hemingway, H., and Banerjee, A.
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OBESITY risk factors , *DIABETES risk factors , *BODY mass index , *KAPLAN-Meier estimator , *ELECTRONIC health records , *PUBLIC health , *COVID-19 pandemic , *COVID-19 , *PHYSICAL activity , *COMORBIDITY - Abstract
Obesity is a modifiable risk factor for coronavirus disease 2019 (COVID-19)–related mortality. We estimated excess mortality in obesity, both 'direct', through infection, and 'indirect', through changes in health care, and also due to potential increasing obesity during lockdown. The study design of this study is a retrospective cohort study and causal inference methods. In population-based electronic health records for 1,958,638 individuals in England, we estimated 1-year mortality risk ('direct' and 'indirect' effects) for obese individuals, incorporating (i) pre-COVID-19 risk by age, sex and comorbidities, (ii) population infection rate and (iii) relative impact on mortality (relative risk [RR]: 1.2, 1.5, 2.0 and 3.0). Using causal inference models, we estimated impact of change in body mass index (BMI) and physical activity during 3-month lockdown on 1-year incidence for high-risk conditions (cardiovascular diseases, diabetes, chronic obstructive pulmonary disease and chronic kidney disease), accounting for confounders. For severely obese individuals (3.5% at baseline), at 10% population infection rate, we estimated direct impact of 240 and 479 excess deaths in England at RR 1.5 and 2.0, respectively, and indirect effect of 383–767 excess deaths, assuming 40% and 80% will be affected at RR = 1.2. Owing to BMI change during the lockdown, we estimated that 97,755 (5.4%: normal weight to overweight, 5.0%: overweight to obese and 1.3%: obese to severely obese) to 434,104 individuals (15%: normal weight to overweight, 15%: overweight to obese and 6%: obese to severely obese) would be at higher risk for COVID-19 over one year. Prevention of obesity and promotion of physical activity are at least as important as physical isolation of severely obese individuals during the pandemic. • In severely obese individuals, we estimated a direct impact of 240–479 excess deaths in England and indirect effect of 383–767 excess deaths over 1 year, assuming 10% infection rate. • Between 97 755 and 434 104 individuals may develop high-risk conditions for coronavirus disease 2019 (COVID-19) mortality during a 3-month lockdown due to change in body mass index and physical activity. • These analyses support COVID-19 and non-COVID-19 impact assessment in policy planning. • The implications of distancing and isolation measures on incidence and mortality from chronic diseases, particularly relating to obesity, need to be considered in clinical practice, public health and research. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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