Coronavirus Disease 2019 Hospitalizations Attributable to Cardiometabolic Conditions in the United States: A Comparative Risk Assessment Analysis

Abstract

BACKGROUND Risk of coronavirus disease 2019 (COVID‐19) hospitalization is robustly linked to cardiometabolic health. We estimated the absolute and proportional COVID‐19 hospitalizations in US adults attributable to 4 major US cardiometabolic conditions, separately and jointly, and by race/ethnicity, age, and sex. METHODS AND RESULTS We used the best available estimates of independent associations of cardiometabolic conditions with a risk of COVID‐19 hospitalization; nationally representative data on cardiometabolic conditions from the National Health and Nutrition Examination Survey 2015 to 2018; and US COVID‐19 hospitalizations stratified by age, sex, and race/ethnicity from the Centers for Disease Control and Prevention’s Coronavirus Disease 2019–Associated Hospitalization Surveillance Network database and from the COVID Tracking Project to estimate the numbers and proportions of COVID‐19 hospitalizations attributable to diabetes mellitus, obesity, hypertension, and heart failure. Inputs were combined in a comparative risk assessment framework, with probabilistic sensitivity analyses and 1000 Monte Carlo simulations to jointly incorporate stratum‐specific uncertainties in data inputs. As of November 18, 2020, an estimated 906 849 COVID‐19 hospitalizations occurred in US adults. Of these, an estimated 20.5% (95% uncertainty interval [UIs], 18.9–22.1) of COVID‐19 hospitalizations were attributable to diabetes mellitus, 30.2% (UI, 28.2–32.3) to total obesity (body mass index ≥30 kg/m 2 ), 26.2% (UI, 24.3–28.3) to hypertension, and 11.7% (UI, 9.5–14.1) to heart failure. Considered jointly, 63.5% (UI, 61.6–65.4) or 575 419 (UI, 559 072–593 412) of COVID‐19 hospitalizations were attributable to these 4 conditions. Large differences were seen in proportions of cardiometabolic risk–attributable COVID‐19 hospitalizations by age and race/ethnicity, with smaller differences by sex. CONCLUSIONS A substantial proportion of US COVID‐19 hospitalizations appear attributable to major cardiometabolic conditions. These results can help inform public health prevention strategies to reduce COVID‐19 healthcare burdens.