Summary of findings 4. Obesity (Unclassified) compared to Normal Weight or Non‐Obese for Adults with COVID‐19.
| Obesity (unclassified) compared to normal BMI or patients with a BMI < 30 kg/m2 for adults with COVID‐19 | |||||||
| Patient or population: Adults with COVID‐19 Settings: Community and in‐hospital | |||||||
| Outcomes Time frame of absolute effects | Absolute effects from study(ies)* (95% CI) | Relative effect 95% CI | No of Participants (studies) | Quality of the evidence (GRADE) | Plain language summary | ||
| Normal BMI or Non‐Obese | Obesity (Unclassified) | Difference with Obesity (Unclassified) | |||||
| Mortality (in‐hospital) | 180 per 1000 | 229 per 1000 (230 to 255) | 49 more per 1000 (39 more to 58 more) | Odds Ratio: 1.35 (CI 95% 1.28 to 1.42)1 | 1,307,520 (54) | ⊕ ⊕ ⊖ ⊖ LOW2 | Obesity (unclassified) may have little or no difference on the risk of mortality. |
| Mechanical ventilation (in‐hospital) | 198 per 1000 | 294 per 1000 (285 to 394) | 96 more per 1000 (64 more to 131 more) | Odds Ratio: 1.69 (CI 95%1.44 to 1.99)3 | 62,348 (21) | ⊕ ⊕ ⊖ ⊖ LOW4 | Obesity (unclassified) may increase the risk of mechanical ventilation. |
| ICU admission (in‐hospital) | 208 per 1000 | 328 per 1000 (291 to 367) | 120 more per 1000 (83 more to 159 more) | Odds Ratio: 1.86 (CI 95% 1.56 to 2.21)5 | 70,529 (21) | ⊕ ⊕ ⊕ ⊖ MODERATE6 | Obesity (unclassified) probably increases the risk of ICU admission. |
| Hospitalisation (adjusted for age, sex, DM, HTN, and cardiovascular disease) (30 days, community) | 257 per 1000 | 312 per 1000 (308 to 370) | 55 more per 1000 (36 more to 75 more) | Odds Ratio: 1.31 (CI 95% 1.2 to 1.44)7 | 510,405 (14) | ⊕ ⊕ ⊕ ⊖ MODERATE8 | Obesity (unclassified) probably increases the risk of hospitalisation. |
| Severe COVID (30‐days, community) | 191 per 1000 | 314 per 1000 (309 to 443) | 123 more per 1000 (86 more to 163 more) | Odds Ratio: 1.94 (CI 95% 1.62 to 2.32)9 | 878,804 (19) | ⊕ ⊕ ⊕ ⊕ HIGH10 | Obesity (unclassified) increases the risk of severe COVID. |
| Pneumonia (30‐days, community) | 300 per 1000 | 382 per 1000 (363 to 516) | 82 more per 1000 (41 more to 124 more) | Odds Ratio: 1.44 (CI 95% 1.21 to 1.72)11 | 35,924 (5) | ⊕ ⊕ ⊕ ⊖ MODERATE12 | Obesity (unclassified) probably increases the chance of pneumonia due to COVID. |
| Hospitalisation (30 days, community) | 257 per 1000 | 340 per 1000 (317 to 362) | 83 more per 1000 (60 more to 105 more) | Odds Ratio: 1.31 (CI 95% 1.2 to 1.44)7 | 515,517 (20) | ⊕ ⊕ ⊖ ⊖ LOW13 | Obesity (unclassified) may increase the risk of hospitalisation. |
| *The basis for the control group absolute risks from the study(ies) is mean risk across study(ies) unless otherwise stated in comments. The intervention absolute risk and difference is based on the risk in the comparison group and the relative effect of the intervention (and its 95% CI). | |||||||
| GRADE Working UserGroup grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | |||||||
1. Systematic review. Baseline/comparator control arm of reference used for intervention.
2. Inconsistency: serious. There was a considerable I‐squared value. We decided to rate down twice for inconsistency and imprecision. Imprecision: serious. The pooled effect estimate was right below our prespecified threshold of absolute risk difference of 50 in every 1000 COVID patients.
3. Systematic review. Baseline/comparator control arm of reference used for intervention.
4. Inconsistency: serious. Many CIs did not overlap and there was a high I‐squared value. The subgroup analysis did not explain the heterogeneity. Publication bias: serious. Asymmetrical funnel plot.
5. Systematic review. Baseline/comparator control arm of reference used for intervention.
6. Inconsistency: serious. The confidence interval of some of the studies did not overlap with those of most included studies/the point estimate of some of the included studies. The magnitude of statistical heterogeneity was high, with an I‐squared of about 80%.
7. Systematic review. Baseline/comparator control arm of reference used for intervention.
8. Imprecision: serious. Even though a part of the width of the confidence interval was due to the heterogeneity, the pooled confidence interval spanned rather symmetrically around the absolute risk difference threshold of 50 in 1000.
9. Systematic review. Baseline/comparator control arm of reference used for intervention.
10. No reasons to rate down.
11. Systematic review. Baseline/comparator control arm of reference used for intervention.
12.Imprecision: serious. The lower bound of the confidence interval crossed the prespecified threshold of 50 in 1000 for the absolute risk difference.
13. Inconsistency: serious. Some of the confidence intervals did not overlap with the pooled confidence interval. These different studies require different and conflicting interpretation of their results. Publication bias: serious. An asymmetric funnel plot was observed.
Note: BMI ‐ Body Mass Index; CI ‐ Confidence Interval; GRADE ‐ Grading of Recommendations, Assessment, Development and Evaluations