High BMI linked to COVID-19 severity in African Americans

New research has identified some common factors associated with severe cases of COVID-19 in African American people, including a high body mass index (BMI).

A new study explores some underlying risk factors for severe COVID-19 among African Americans.

The research, published in the journal Obesity, focused on African American people because they are disproportionately affected by the disease, which results from infection with the new coronavirus.

COVID-19 disparities

While all people have a risk of contracting the infection and developing the disease, this risk is not equally distributed.

As the Centers for Disease Control and Prevention (CDC) note, “Long-standing systemic health and social inequities have put many people from racial and ethnic minority groups at increased risk of getting sick and dying from COVID-19.”

Various studies and reviews have demonstrated this disproportionate impact. The articles consistently point to an association between ethnicity and race and COVID-19 severity, highlighting that the disease and our approach to it must be understood in socioeconomic, as well as biological, terms.

As a commentary in the journal BMJ Global Health notes, “Racism, segregation, and inequality, which have been for decades invisibly and pervasively embedded in dominant cultures and social institutions, now emerge as a monumental COVID-19 challenge.”

Even as structural racism requires a wholescale reckoning, understanding the factors beyond systemic inequity that contribute to a high rate of severe COVID-19 among African Americans can help doctors respond effectively.

Dr. Christine Bojanowski, an assistant professor at Tulane University’s School of Medicine, in New Orleans, LA, and the corresponding author of the present study, notes, “It is of tremendous importance that we identify risk factors and those individuals who may be at increased risk for severe COVID-19 infection, so that we are able [to] dedicate efforts toward supporting those most affected and in need.”

“This study is of particular interest in response to emerging reports revealing the disproportionate impact of COVID-19 on the African American community in our country. Further inclusive research aimed at optimizing clinical care relevant to the African American population is critical to ensure an equitable response to COVID-19.”

158 participants

The analysis included African American patients with confirmed COVID-19 who presented to an academic hospital between March 12 and April 9, 2020. In total, the study included 158 participants, 61% of whom were women. The participants’ average age was 57.

The study recorded whether the patients had required treatment in an intensive care unit (ICU), using this to define whether they had experienced severe COVID-19. The participants’ general health was identified retrospectively, by looking at their medical records.

Among the patients with severe COVID-19, 85% required intubation and mechanical ventilation due to respiratory failure.

In total, 37% of the patients receiving ICU care died. However, the actual figure may be higher, as more than one-fifth of the patients were still receiving ventilation in the ICU when the analysis took place.

Obesity, age, and health conditions

The researchers found that the patients who required ICU treatment were typically older, with an average age of 62 years. They also had a higher average BMI: 36.5 vs. 31.9.

In addition, the analysis showed that hypertension and lung disease were predictors of severe COVID-19.

The team notes that obesity is only just beginning to be linked with COVID-19 and recommend that further research explores the association. At the end of June, the CDC updated their guidance to report that anyone with a BMI of 30 or above has a risk of severe disease.

In a commentary on the present study, Dr. Keith C. Ferdinand, a professor of medicine and chair of preventive cardiology at Tulane’s School of Medicine emphasizes that “Instead of stigmatization of black adults with obesity, this pandemic, a hopefully once-in-a-century health crisis, is a clarion call to decrease and eventually eliminate long-standing health disparities and underlying adverse societal structural factors.”

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