{"doi":"10.1101/2020.09.02.20185173","title":"Characteristics and outcomes of 627 044 COVID-19 patients with and without obesity in the United States, Spain, and the United Kingdom","abstract":"Abstract Background COVID-19 may differentially impact people with obesity. We aimed to describe and compare the demographics, comorbidities, and outcomes of obese patients with COVID-19 to those of non-obese patients with COVID-19, or obese patients with seasonal influenza. Methods We conducted a cohort study based on outpatient/inpatient care, and claims data from January to June 2020 from the US, Spain, and the UK. We used six databases standardized to the OMOP common data model. We defined two cohorts of patients diagnosed and/or hospitalized with COVID-19. We created corresponding cohorts for patients with influenza in 2017-2018. We followed patients from index date to 30 days or death. We report the frequency of socio-demographics, prior comorbidities, and 30-days outcomes (hospitalization, events, and death) by obesity status. Findings We included 627 044 COVID-19 (US: 502 650, Spain: 122 058, UK: 2336) and 4 549 568 influenza (US: 4 431 801, Spain: 115 224, UK: 2543) patients. The prevalence of obesity was higher among hospitalized COVID-19 (range: 38% to 54%) than diagnosed COVID-19 (30% to 47%), or diagnosed (15% to 47%) or hospitalized (27% to 48%) influenza patients. Obese hospitalized COVID-19 patients were more often female and younger than non-obese COVID-19 patients or obese influenza patients. Obese COVID-19 patients were more likely to have prior comorbidities, present with cardiovascular and respiratory events during hospitalization, require intensive services, or die compared to non-obese COVID-19 patients. Obese COVID-19 patients were more likely to require intensive services or die compared to obese influenza patients, despite presenting with fewer comorbidities. Interpretation We show that obesity is more common amongst COVID-19 than influenza patients, and that obese patients present with more severe forms of COVID-19 with higher hospitalization, intensive services, and fatality than non-obese patients. These data are instrumental for guiding preventive strategies of COVID-19 infection and complications. Funding The European Health Data & Evidence Network has received funding from the Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement No 806968. The JU receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA. This research received partial support from the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), US National Institutes of Health, US Department of Veterans Affairs, Janssen Research & Development, and IQVIA. The University of Oxford received funding related to this work from the Bill & Melinda Gates Foundation (Investment ID INV-016201 and INV-019257). APU has received funding from the Medical Research Council (MRC) [MR/K501256/1, MR/N013468/1] and Fundación Alfonso Martín Escudero (FAME) (APU). VINCI [VA HSR RES 13-457] (SLD, MEM, KEL). JCEL has received funding from the Medical Research Council (MR/K501256/1) and Versus Arthritis (21605). No funders had a direct role in this study. The views and opinions expressed are those of the authors and do not necessarily reflect those of the Clinician Scientist Award programme, NIHR, Department of Veterans Affairs or the United States Government, NHS, or the Department of Health, England. Research in context Evidence before this study Previous evidence suggests that obese individuals are a high risk population for COVID-19 infection and complications. We searched PubMed for articles published from December 2019 until June 2020, using terms referring to SARS-CoV-2 or COVID-19 combined with terms for obesity. Few studies reported obesity and most of them were limited by small sample sizes and restricted to hospitalized patients. Further, they used different definitions for obesity (i.e. some reported together overweight and obesity, others only reported obesity with BMI>40kg/m 2 ). To date, no study has provided detailed information on","journal":"medRxiv","year":2020,"id":121873,"datarank":0.3507022567281032,"base_score":1.9459101490553132,"endowment":1.9459101490553132,"self_citation_contribution":0.29188652235829704,"citation_network_contribution":0.058815734369806166,"self_endowment_contribution":0.29188652235829704,"citer_contribution":0.058815734369806166,"corpus_percentile":49.73311673242051,"corpus_rank":6499,"citation_count":6,"citer_count":3,"citers_with_citation_signal":3,"citers_with_endowment":3,"datacite_reuse_total":0,"is_dataset":true,"is_dataset_confidence":0.7019,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":32070,"name":"Elena Roel","orcid":"0000-0002-1964-3546","position":1,"is_corresponding":false},{"id":32071,"name":"Andrea Pistillo","orcid":"0000-0002-4467-0220","position":2,"is_corresponding":false},{"id":32056,"name":"Anthony G. Sena","orcid":"0000-0001-8630-5347","position":3,"is_corresponding":false},{"id":258108,"name":"Albert Prats‐Uribe","orcid":"0000-0003-1202-9153","position":4,"is_corresponding":false},{"id":552594,"name":"Waheed‐Ul‐Rahman Ahmed","orcid":"0000-0003-0880-0355","position":5,"is_corresponding":false},{"id":258088,"name":"Heba Alghoul","orcid":"0000-0001-8234-5843","position":6,"is_corresponding":false},{"id":32109,"name":"Thamir M. Alshammari","orcid":"0000-0002-5630-2468","position":7,"is_corresponding":false},{"id":258089,"name":"Osaid Alser","orcid":"0000-0001-6743-803X","position":8,"is_corresponding":false},{"id":266938,"name":"Carlos Areia","orcid":"0000-0002-4668-7069","position":9,"is_corresponding":false},{"id":258091,"name":"Edward Burn","orcid":"0000-0002-9286-1128","position":10,"is_corresponding":false},{"id":258092,"name":"Paula Casajust","orcid":"0000-0003-2733-5436","position":11,"is_corresponding":false},{"id":562096,"name":"Dalia Dawoud","orcid":"0000-0002-2105-1937","position":12,"is_corresponding":false},{"id":11351,"name":"Scott L. DuVall","orcid":"0000-0002-4898-3865","position":13,"is_corresponding":false},{"id":266935,"name":"Thomas Falconer","orcid":"0000-0001-6904-1394","position":14,"is_corresponding":false},{"id":258095,"name":"Sergio Fernández‐Bertolín","orcid":"0000-0002-0029-6564","position":15,"is_corresponding":false},{"id":277989,"name":"Asieh Golozar","orcid":"0000-0002-4243-155X","position":16,"is_corresponding":false},{"id":552596,"name":"Mengchun Gong","orcid":"0000-0001-8197-6643","position":17,"is_corresponding":false},{"id":32051,"name":"Lana Yin Hui Lai","orcid":"0000-0002-0485-0956","position":18,"is_corresponding":false},{"id":258085,"name":"Jennifer C. E. Lane","orcid":"0000-0002-1729-8654","position":19,"is_corresponding":false},{"id":258103,"name":"Kristine E. Lynch","orcid":"0000-0002-2221-2421","position":20,"is_corresponding":false},{"id":11398,"name":"Michael E. Matheny","orcid":"0000-0003-3217-4147","position":21,"is_corresponding":false},{"id":258105,"name":"Paras Mehta","orcid":"0000-0002-0233-9871","position":22,"is_corresponding":false},{"id":32063,"name":"Daniel R. Morales","orcid":"0000-0002-0063-8069","position":23,"is_corresponding":false},{"id":562608,"name":"Karthik Natarjan","orcid":null,"position":24,"is_corresponding":false},{"id":32103,"name":"Fredrik Nyberg","orcid":"0000-0003-0892-5668","position":25,"is_corresponding":false},{"id":32113,"name":"Jose Posada","orcid":"0000-0003-3864-0241","position":26,"is_corresponding":false},{"id":32077,"name":"Christian Reich","orcid":"0000-0002-3641-055X","position":27,"is_corresponding":false},{"id":277997,"name":"Lisa M. Schilling","orcid":"0000-0002-6878-189X","position":28,"is_corresponding":false},{"id":552600,"name":"Karishma Shah","orcid":"0000-0002-6219-1653","position":29,"is_corresponding":false},{"id":226836,"name":"Nigam H. Shah","orcid":"0000-0001-9385-7158","position":30,"is_corresponding":false},{"id":272182,"name":"Vignesh Subbian","orcid":"0000-0001-9974-8382","position":31,"is_corresponding":false},{"id":258116,"name":"Lin Zhang","orcid":"0000-0002-2064-8440","position":32,"is_corresponding":false},{"id":562097,"name":"Hong Zhu","orcid":"0000-0003-0501-1211","position":33,"is_corresponding":false},{"id":32122,"name":"Patrick Ryan","orcid":"0000-0002-9727-2138","position":34,"is_corresponding":false},{"id":32121,"name":"Daniel Prieto‐Alhambra","orcid":"0000-0002-3950-6346","position":35,"is_corresponding":false},{"id":225287,"name":"Kristin Kostka","orcid":"0000-0003-2595-8736","position":36,"is_corresponding":false},{"id":32111,"name":"Talita Duarte‐Salles","orcid":"0000-0002-8274-0357","position":37,"is_corresponding":false},{"id":552599,"name":"Martina Recalde","orcid":"0000-0003-2256-618X","position":0,"is_corresponding":true}],"reference_count":33,"raw_metadata":null,"created_at":"2026-07-18T23:14:46.979435Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}