Majority of COVID-19 Hospitalizations Due to 4 Chronic Diseases

Obesity, hypertension, diabetes, and heart failure are the chronic diseases that contribute to a majority of adult COVID-19 hospitalizations across the country, a study published in the Journal of the American Heart Association (JAHA) revealed.

Among the 906,849 total COVID-19 hospitalizations that occurred in US adults as of November 18, 2020, researchers estimated that 30 percent were attributable to obesity; 26 percent were attributable to hypertension; 21 percent were due to diabetes; and 12 percent were attributable to heart failure.

The attributable proportion represents the percentage of COVID-19 hospitalizations that could have been prevented if the patient didn’t have one of the four conditions. The study found that while individuals still may have gotten the virus, without one of these pre-existing conditions patients may not have had severe enough illness to require hospitalization.

When researchers combined the numbers for the four chronic conditions, the data analytics model suggests that 64 percent of COVID-19 hospitalizations may have been prevented. A ten percent reduction in national prevalence of each condition, when combined, could prevent about eleven percent of all COVID-19 hospitalizations, according to the model.

The team chose the four conditions based on other published research from around the world showing that each disease is an independent predictor of severe outcomes – including hospitalization – among people with COVID-19.

Researchers used a published multivariable model involving more than 5,000 COVID-19 patients diagnosed in New York earlier in the pandemic to develop the specific risk estimates for each condition.

The team also used other national data to model the number of COVID-19 hospitalizations in the US; the distributions of these hospitalizations by age, sex, and race; and the estimated distribution of the underlying comorbidities among adults infected with COVID-19. Researchers then estimated the proportions and numbers of COVID-19 cases that became severe enough to require hospitalization due to the presence of one or more of the four conditions.

“Medical providers should educate patients who may be at risk for severe COVID-19 and consider promoting preventive lifestyle measures, such as improved dietary quality and physical activity, to improve overall cardiometabolic health. It’s also important for providers to be aware of the health disparities people with these conditions often face,” said first author Meghan O’Hearn, a doctoral candidate at the Friedman School.

The model estimated that age and race/ethnicity resulted in disparities in COVID-19 hospitalizations due to the four conditions. For example, about eight percent of COVID-19 hospitalizations among adults under 50 years old were estimated to be due to diabetes, compared to about 29 percent of COVID-19 hospitalizations among those 65 and older.

In contrast, obesity had an equally detrimental impact on COVID-19 hospitalizations across age groups.

At any age, COVID-19 hospitalizations attributable to all four conditions were higher in black adults than in white adults and generally higher in for diabetes and obesity in Hispanic adults than in white adults. For example, among adults age 65 and older, diabetes was estimated to cause about 25 percent of COVID-19 hospitalizations among white adults versus about 32 percent among black adults and 34 percent among Hispanic adults.

When the four conditions were considered combined, the proportion of attributable hospitalizations was highest in black adults of all ages, followed by Hispanics. Among young adults 18-49 years old, the four conditions were jointly estimated to cause about 39 percent of COVID-19 hospitalizations among white adults, versus 50 percent among black adults.

“National data show that Black and Hispanic Americans are suffering the worst outcomes from COVID-19. Our findings lend support to the need for prioritizing vaccine distribution, good nutrition, and other preventive measures to people with cardiometabolic conditions, particularly among groups most affected by health disparities,” Mozaffarian said.

“Policies aimed at reducing the prevalence of these four cardiometabolic conditions among Black and Hispanic Americans must be part of any state or national policy discussion aimed at reducing health disparities from COVID-19.”

The study’s results demonstrate the need to improve individuals’ overall health – particularly in populations hardest hit by health disparities.

“While newly authorized COVID-19 vaccines will eventually reduce infections, we have a long way to go to get to that point. Our findings call for interventions to determine whether improving cardiometabolic health will reduce hospitalizations, morbidity, and healthcare strains from COVID-19,” said Dariush Mozaffarian, lead author and dean of the Friedman School.

“We know that changes in diet quality alone, even without weight loss, rapidly improve metabolic health within just six to eight weeks. It’s crucial to test such lifestyle approaches for reducing severe COVID-19 infections, both for this pandemic and future pandemics likely to come.”