Diabetes, Obesity, Hypertension, and Cardiovascular Disease Linked to Most COVID-19 Hospitalizations

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Diabetes, obesity, high blood pressure, and cardiovascular disease account for the majority of COVID-19 hospitalizations, suggests a new study.Researchers estimate a 10 percent reduction in the number of people …

Mario Tama/Getty Images
  • Diabetes, obesity, high blood pressure, and cardiovascular disease account for the majority of COVID-19 hospitalizations, suggests a new study.
  • Researchers estimate a 10 percent reduction in the number of people with each of these conditions could have potentially prevented about 11 percent of COVID-19 hospitalizations. 
  • Experts say physicians should help people manage these conditions to decrease their risk of severe COVID-19.

Certain medical conditions increase the risk of severe COVID-19. Four of these account for the majority of COVID-19 hospitalizations, suggests a recent study.

Researchers estimated that of the more than 900,000 COVID-19 hospitalizations that occurred in the United States through mid-November 2020, 30 percent could be attributed to obesity; 26 percent to high blood pressure; 21 percent to diabetes; and 12 percent to heart failure.

Combined, these four cardiometabolic conditions accounted for almost two-thirds of the COVID-19 hospitalizations during that period, estimate the researchers.

This suggests that if people had not had these conditions, these hospitalizations could have been prevented.

The researchers also estimate that a 10 percent reduction in the number of people with each of these conditions could have prevented about 11 percent of COVID-19 hospitalizations. 

The authors believe that more should be done to help people reduce their risks from these four cardiometabolic conditions, such as through lifestyle changes like improved diet and regular physical activity.

“Our findings call for interventions to determine whether improving cardiometabolic health will reduce hospitalizations, morbidity, and health care strains from COVID-19,” said study author Dr. Dariush Mozaffarian, dean of the Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University, in a news release.

Some of these lifestyle changes could produce noticeable health benefits within a short time.

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

The study was published online February 25 in the Journal of the American Heart Association

Older adults and marginalized groups impacted more

For their study, researchers used a mathematical model to estimate the number of COVID-19 hospitalizations that could have been prevented if Americans did not have these four cardiometabolic conditions.

The hospitalization risks for each of the conditions was based on data from more than 5,000 COVID-19 patients diagnosed in New York City earlier in the pandemic.

Researchers also used other national data on COVID-19 hospitalizations and the rates of underlying health conditions among people with COVID-19 to extend these risks to the national level.

The new study also showed that older age increased the COVID-19 risks associated with each of the four conditions.

For example, researchers estimated that about 8 percent of COVID-19 hospitalizations in adults under 50 years old were due to diabetes, compared to about 29 percent among those 65 and older.

A similar age-related trend was seen for high blood pressure and heart failure. In contrast, obesity was equally harmful for all age groups — accounting for about 30 percent of COVID-19 hospitalizations.

Black and Hispanic adults were also impacted more by these four conditions.

Hispanic adults had a higher rate of COVID-19 hospitalizations due to diabetes and obesity than white adults. Black adults were at higher risk for hospitalizations for COVID-19 that were also attributed to these four conditions compared to white adults.

“National data show that Black and Hispanic Americans are suffering the worst outcomes from COVID-19,” Mozaffarian said. “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.”

Managing chronic conditions lowers risk

Because this is a modeling study, it doesn’t show that these diseases are directly responsible for more severe COVID-19. 

But Dr. Daniel Drucker, an endocrinologist and diabetes researcher at Mount Sinai Hospital in Toronto, says the results fit with what has been seen in earlier research.

“We’re about a year into the pandemic, and there have been dozens of epidemiological studies all over the world looking at this,” he said. “The results are all quite consistent that diabetes, obesity, and cardiovascular disease are the top three [COVID-19] risk factors, in addition to age.”

One study from the Centers for Disease Control and Prevention (CDC) shows how much impact these cardiometabolic conditions can have on COVID-19 risk.

The data from that study show that a 35-year-old with an underlying health condition such as diabetes or heart disease has about the same risk of being hospitalized for COVID-19 as a 75-year-old with no underlying health condition.

In addition, a 35-year-old with an underlying health condition also has about the same risk of dying from COVID-19 as a 65-year-old with no other health problems.

While age is a risk factor for severe COVID-19, it’s not one we can change. But conditions like obesity, diabetes, and cardiovascular disease are potentially modifiable, either through lifestyle changes or medications.

Drucker says one thing missing from the new study is data on the COVID-19 hospitalization risk for well-managed health conditions versus uncontrolled conditions.

“There is overwhelming evidence that if you have either type 2 diabetes or type 1 diabetes, and you have excellent blood sugar control, then you have a very low risk of having an adverse COVID-19 outcome,” he said.

He says even someone with “healthy obesity” — a person whose BMI puts them in the obese category, but who eats healthy and exercises regularly — will have a different risk from another person with obesity who doesn’t do those things.

The authors of the new study believe that physicians and other healthcare providers should do more to help people manage their conditions and improve their health. 

This includes understanding the barriers that keep people with these conditions from meeting regularly with healthcare providers, affording their medication, or developing healthier habits.

Drucker says by emphasizing that managing chronic conditions could lower COVID-19 risk, some people may be motivated to make changes.

“If you’re healthy with diabetes or you’re healthy with obesity, you’re probably at low risk [of COVID-19],” he said. 

“And if you’re not at your goals for your diabetes, obesity, or blood pressure, this should be additional motivation to say, ‘Hey, what can I do to make myself healthier?’”