Covid-19 carries higher risk for morbidly obese men with heart disease – study

Covid-19 carries a “significantly higher risk” of death for morbidly obese men with chronic heart disease than other patient profiles, a new study has found.

Research examining almost 20,000 Irish hospital experiences, published in the Lancet, also found that chronic neurological conditions, chronic kidney disease and cancer brought higher mortality rates.

The study looked at underlying conditions associated with disease severity including mortality, hospitalisation and admission to intensive care units (ICUs).

Conducted by RCSI University of Medicine and Health Sciences and the HSE Health Protection Surveillance Centre (HPSC), its findings are consistent with other reports but it is the first to examine the health associations in an Irish setting.

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It drew from HPSC data relating to confirmed cases from the first wave of the pandemic between March and July 2020.

There were 19,789 cases included, encompassing 1,476 deaths (7.5 per cent); 2,811 hospitalisations (14.2 per cent); and 438 ICU admissions (2.2 per cent), of which 90 resulted in death (20.5 per cent).

It found that most chronic conditions were significantly associated with increased risk of hospitalisation.

Among those who were hospitalised, chronic heart disease, asthma (requiring medication) and morbid obesity (defined as a body mass index equal to or greater than 40) were associated with increased risk of ICU admission.

Chronic neurological conditions, chronic kidney disease, obesity and cancer were all significantly associated with increased risk of death.

Population- based research

"This study is the first population-based research to capture data across all settings in Ireland, including both community and hospital settings, and so it gives us a better picture of the impact of the disease on patients at the population level," said Prof Kathleen Bennett, associate professor in biostatistics at the RCSI.

“The findings are of particular relevance as the national vaccination programme is well under way, including those at very high risk and high risk from the most severe outcomes of Covid-19.”

The European Centre for Disease Prevention and Control has reported that the top three underlying conditions found among fatal cases are cardiac disorder, diabetes and cancer.

The Irish experience among men is also in line with other studies. The report notes that a systematic review of 16 studies – from China, the United States, Italy, the UK and Spain among others – men had increased disease severity, including hospitalisation and ICU admission.

“Although it is not fully understood why men are more susceptible to a severe disease trajectory, many factors have been proposed that may underlie these differences, including immunological differences, elevated expression of certain factors including angiotensin-converting enzyme 2, differences in hormones and also social and behavioural differences,” the report says. “It is likely, however, that these differences are multifactorial and complex.”

The majority of those who test positive for Covid-19 will survive the disease. The report notes that both the United States Centres for Disease Control and Prevention and the World Health Organisation state that about 80 per cent of those who test positive for the virus experience a mild illness or are asymptomatic.