Associations of diabetes, hypertension and obesity with COVID-19 mortality: a systematic review and meta-analysis

• Published in: BMJ global health Vol. 8; no. 12; p. e012581
• Main Authors: Li, Chaoyang, Islam, Nazrul, Gutierrez, Juan Pablo, Gutiérrez-Barreto, Samuel Eloy, Castañeda Prado, Andrés, Moolenaar, Ronald L, Lacey, Ben, Richter, Patricia
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 14-12-2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Chronic illnesses; Comorbidity; Coronaviruses; COVID-19; Diabetes; Diabetes Mellitus - epidemiology; Global health; Heterogeneity; Humans; Hypertension; Hypertension - epidemiology; Medical records; Mortality; Obesity; Obesity - epidemiology; Original Research; Pandemics; Risk assessment; Risk Factors; Systematic review; Africa; COVID-19; Hypertension; Systematic review; Diabetes
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2023-012581

IntroductionDespite a growing body of scholarly research on the risks of severe COVID-19 associated with diabetes, hypertension and obesity, there is a need for estimating pooled risk estimates with adjustment for confounding effects. We conducted a systematic review and meta-analysis to estimate the pooled adjusted risk ratios of diabetes, hypertension and obesity on COVID-19 mortality.MethodsWe searched 16 literature databases for original studies published between 1 December 2019 and 31 December 2020. We used the adapted Newcastle-Ottawa Scale to assess the risk of bias. Pooled risk ratios were estimated based on the adjusted effect sizes. We applied random-effects meta-analysis to account for the uncertainty in residual heterogeneity. We used contour-funnel plots and Egger’s test to assess possible publication bias.ResultsWe reviewed 34 830 records identified in literature search, of which 145 original studies were included in the meta-analysis. Pooled adjusted risk ratios were 1.43 (95% CI 1.32 to 1.54), 1.19 (95% CI 1.09 to 1.30) and 1.39 (95% CI 1.27 to 1.52) for diabetes, hypertension and obesity (body mass index ≥30 kg/m2) on COVID-19 mortality, respectively. The pooled adjusted risk ratios appeared to be stronger in studies conducted before April 2020, Western Pacific Region, low- and middle-income countries, and countries with low Global Health Security Index scores, when compared with their counterparts.ConclusionsDiabetes, hypertension and obesity were associated with an increased risk of COVID-19 mortality independent of other known risk factors, particularly in low-resource settings. Addressing these chronic diseases could be important for global pandemic preparedness and mortality prevention.PROSPERO registration numberCRD42021204371.