Two-Thirds of COVID-19 Hospitalizations Are Due to These Four Conditions

Four Pre-existing Conditions COVID-19 Hospitalizations

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Study recommends COVID-19 hospitalizations might have been avoided without 4 typical pre-existing conditions. Credit: Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University

Model recommends greater danger based upon race and age, provides insights to minimize illness effect.

A modeling research study recommends a bulk of grownup COVID-19 hospitalizations across the country are attributable to a minimum of among 4 pre-existing conditions: weight problems, high blood pressure, diabetes, and cardiac arrest, because order.

The research study, released today (February 25, 2021) in the Journal of the American Heart Association (JAHA) and led by scientists at the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University, utilized a mathematical simulation to approximate the number and percentage of nationwide COVID-19 hospitalizations that might have been avoided if Americans did not struggle with 4 significant cardiometabolic conditions. Each condition has actually been highly connected in other research studies to increased danger of bad results with COVID-19 infection.

“While newly authorized COVID-19 vaccines will eventually reduce infections, we have a long way to go to get to that point. Our findings call for interventions to determine whether improving cardiometabolic health will reduce hospitalizations, morbidity, and health care strains from COVID-19,” stated Dariush Mozaffarian, lead author and dean of the Friedman School. “We know that changes in diet quality alone, even without weight loss, rapidly improve metabolic health within just six to eight weeks. 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 scientists approximated that, amongst the 906,849 overall COVID-19 hospitalizations that had actually taken place in U.S. grownups since November 18, 2020:

  • 30% (274,322) were attributable to weight problems;
  • 26% (237,738) were attributable to high blood pressure;
  • 21% (185,678) were attributable to diabetes; and
  • 12% (106,139) were attributable to cardiac arrest.

In epidemiological terms, the attributable percentage represents the portion of COVID-19 hospitalizations that might have been avoided in the lack of the 4 conditions. In other words, the research study discovered the people may still have actually been contaminated however might not have had a serious adequate scientific course to need hospitalization. When numbers for the 4 conditions were integrated, the design recommends 64% (575,419) of COVID-19 hospitalizations may have been avoided. A 10% decrease in nationwide frequency of each condition, when integrated, might avoid about 11% of all COVID-19 hospitalizations, according to the design.

The 4 conditions were selected based upon other released research study from around the globe revealing each is an independent predictor of extreme results, consisting of hospitalization, amongst individuals contaminated with COVID-19. The particular danger price quotes for each condition were from a released multivariable design including more than 5,000 COVID-19 clients identified in New York City previously in the pandemic. The scientists utilized other nationwide information to design the variety of COVID-19 hospitalizations nationally; the circulations of these hospitalizations by age, sex, and race; and the projected circulation of the underlying comorbidities amongst grownups contaminated with COVID-19. They then approximated the percentages and varieties of COVID-19 cases that ended up being extreme adequate to need hospitalization owing to the existence of several of the conditions.

“Medical providers should educate patients who may be at risk for severe COVID-19 and consider promoting preventive lifestyle measures, such as improved dietary quality and physical activity, to improve overall cardiometabolic health. It’s also important for providers to be aware of the health disparities people with these conditions often face,” stated very first author Meghan O’Hearn, a doctoral prospect at the Friedman School.

The design approximated that age and race/ethnicity led to variations in COVID-19 hospitalizations due to the 4 conditions. For example, about 8% of COVID-19 hospitalizations amongst grownups under 50 years of ages were approximated to be due to diabetes, compared to about 29% of COVID-19 hospitalizations amongst those age 65 and older. In contrast, weight problems had a similarly destructive influence on COVID-19 hospitalizations throughout age.

At any age, COVID-19 hospitalizations attributable to all 4 conditions were greater in Black grownups than in white grownups and usually greater for diabetes and weight problems in Hispanic grownups than in white grownups. For example, amongst grownups age 65 and older, diabetes was approximated to trigger about 25% of COVID-19 hospitalizations amongst white grownups, versus about 32% amongst Black grownups, and about 34% amongst Hispanic grownups.

When the 4 conditions were thought about combined, the percentage of attributable hospitalizations was greatest in Black grownups of any ages, followed by Hispanics. For example, amongst young people 18-49 years of ages, the 4 conditions collectively were approximated to trigger about 39% of COVID-19 hospitalizations amongst white grownups, versus 50% amongst Black grownups.

“National data show that Black and Hispanic Americans are suffering the worst outcomes from COVID-19. 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,” Mozaffarian stated. “Policies aimed at reducing the prevalence of these four cardiometabolic conditions among Black and Hispanic Americans must be part of any state or national policy discussion aimed at reducing health disparities from COVID-19.”


The design utilized existing information from numerous sources. Hospitalizations by age, sex, race and ethnic culture originated from the CDC’s COVID-NET system, which tracks COVID-19 hospitalizations in 14 getting involved states. Data on nationwide COVID-19 hospitalizations originated from The COVID Tracking Project, a volunteer company that gathers information from all 50 states on the COVID-19 break out in the U.S. These 2 datasets were integrated to approximate COVID-19 hospitalizations at the nationwide level by population sub-groups. The information on the nationwide circulation of the 4 conditions originated from the most current National Health and Nutrition Examination Survey (NHANES), a nationally representative research study in which individuals go through medical exams and lab tests. Data on the association in between COVID-19 hospitalizations and each of the 4 conditions originated from a research study on aspects connected with health center admission amongst individuals with COVID-19 in New York City.


The authors keep in mind that association does not equivalent causation, and the modeling technique does not show decreases in the 4 conditions will minimize COVID-19 hospitalizations. Assumptions were based upon restricted readily available information on the cardiometabolic condition circulation amongst COVID-19 contaminated U.S. grownups, the group breakdown of COVID-19 hospitalizations nationally, and the greatest proof to date on links in between cardiometabolic conditions and bad COVID-19 results.


Additional authors on the research study are Frederick Cudhea and Renata Micha at the Friedman School, and Junxiu Liu, a postdoctoral scholar at the Friedman School at the time of the research study, now assistant teacher at the Icahn School of Medicine at Mount Sinai.


This work was supported by 2 awards from the National Institutes of Health’s National Heart, Lung, and Blood Institute (R01HL130735 and R01HL115189). The material is entirely the duty of the authors and does not always represent the main views of the National Institutes of Health. See the research study for disputes of interest.


O’Hearn, M., Liu, J., Cudhea, F., Micha, R., & Mozaffarian, D. (2021). COVID-19 hospitalizations attributable to cardiometabolic conditions in the U.S.: A relative danger evaluation analysis. Journal of the American Heart Association.

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