Association of cardiometabolic risk factors with hospitalisation or death due to COVID-19: population-based cohort study in Sweden (SCAPIS)

Per Tornhammar; Tomas Jernberg; Göran Bergström; Anders Blomberg; Gunnar Engström; Jan Engvall; Tove Fall; Magnus Gisslén; Christer Janson; Lars Lind; C Magnus Sköld; Johan Sundström; Stefan Söderberg; Suneela Zaigham; Carl Johan Östgren; Daniel Peter Andersson; Peter Ueda

doi:10.1136/bmjopen-2021-051359

Association of cardiometabolic risk factors with hospitalisation or death due to COVID-19: population-based cohort study in Sweden (SCAPIS)

BMJ Open. 2021 Sep 2;11(9):e051359. doi: 10.1136/bmjopen-2021-051359.

Authors

Per Tornhammar¹, Tomas Jernberg², Göran Bergström^{3

4}, Anders Blomberg⁵, Gunnar Engström⁶, Jan Engvall^{7

8}, Tove Fall⁹, Magnus Gisslén^{10

11}, Christer Janson¹², Lars Lind¹³, C Magnus Sköld^{14

15}, Johan Sundström^{13

16}, Stefan Söderberg⁵, Suneela Zaigham⁶, Carl Johan Östgren⁸, Daniel Peter Andersson¹⁷, Peter Ueda¹⁸

Affiliations

¹ Functional Area of Emergency Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden.
² Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden.
³ Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁴ Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁵ Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden.
⁶ Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.
⁷ CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
⁸ Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
⁹ Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
¹⁰ Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
¹¹ Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
¹² Department of Medical Sciences, Respiratory-, Allergy- and Sleep Research, Uppsala University, Uppsala, Sweden.
¹³ Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
¹⁴ Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Stockholm, Sweden.
¹⁵ Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden.
¹⁶ The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
¹⁷ Department of Medicine Huddinge H7, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
¹⁸ Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden peter.ueda@ki.se.

Abstract

Objective: To assess the association of cardiometabolic risk factors with hospitalisation or death due to COVID-19 in the general population.

Design, setting and participants: Swedish population-based cohort including 29 955 participants.

Exposures: Cardiometabolic risk factors assessed between 2014 and 2018.

Main outcome measures: Hospitalisation or death due to COVID-19, as registered in nationwide registers from 31 January 2020 through 12 September 2020. Associations of cardiometabolic risk factors with the outcome were assessed using logistic regression adjusted for age, sex, birthplace and education.

Results: Mean (SD) age was 61.2 (4.5) and 51.5% were women. 69 participants experienced hospitalisation or death due to COVID-19. Examples of statistically significant associations between baseline factors and subsequent hospitalisation or death due to COVID-19 included overweight (adjusted OR (aOR) vs normal weight 2.73 (95% CI 1.25 to 5.94)), obesity (aOR vs normal weight 4.09 (95% CI 1.82 to 9.18)), pre-diabetes (aOR vs normoglycaemia 2.56 (95% CI 1.44 to 4.55)), diabetes (aOR vs normoglycaemia 3.96 (95% CI 2.13 to 7.36)), sedentary time (aOR per hour/day increase 1.10 (95% CI 1.02 to 1.17)), grade 2 hypertension (aOR vs normotension 2.44 (95% CI 1.10 to 5.44)) and high density lipoprotein cholesterol (aOR per mmol/L increase 0.33 (95% CI 0.17 to 0.65)). Statistically significant associations were not observed for grade 1 hypertension (aOR vs normotension 1.03 (95% CI 0.55 to 1.96)), current smoking (aOR 0.56 (95% CI 0.24 to 1.30)), total cholesterol (aOR per mmol/L increase 0.90 (95% CI 0.71 to 1.13)), low density lipoprotein cholesterol (aOR per mmol/L increase 0.90 (95% CI 0.69 to 1.15)) and coronary artery calcium score (aOR per 10 units increase 1.00 (95% CI 0.99 to 1.01)).

Conclusions: In a large population-based sample from the general population, several cardiometabolic risk factors were associated with hospitalisation or death due to COVID-19.

Keywords: COVID-19; cardiac epidemiology; epidemiology.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19*
Cardiometabolic Risk Factors
Cohort Studies
Female
Hospitalization
Humans
Risk Factors
SARS-CoV-2
Sweden / epidemiology