Association of Obesity and Diabetes With SARS-CoV-2 Infection and Symptoms in the COVID-19 Community Research Partnership

Abstract

Context: Obesity and diabetes are established risk factors for severe SARS-CoV-2 outcomes, but less is known about their impact on susceptibility to COVID-19 infection and general symptom severity. Objective: We hypothesized that those with obesity or diabetes would be more likely to self-report a positive SARS-CoV-2 test, and, among those with a positive test, have greater symptom severity and duration. Methods: Among 44 430 COVID-19 Community Research Partnership participants, we evaluated the association of self-reported and electronic health record obesity and diabetes with a self-reported positive COVID-19 test at any time. Among the 2663 participants with a self-reported positive COVID-19 test during the study, we evaluated the association of obesity and diabetes with self-report of symptom severity, duration, and hospitalization. Logistic regression models were adjusted for age, sex, race/ethnicity, socioeconomic status, and health care worker status. Results: We found a positive graded association between body mass index (BMI) category and positive COVID-19 test (overweight odds ratio [OR] 1.14 [1.05-1.25]; obesity I OR 1.29 [1.17-2.42]; obesity II OR 1.34 [1.19-1.50]; obesity III OR 1.53 [1.35-1.73]), and a similar but weaker association with COVID-19 symptoms and severity among those with a positive test. Diabetes was associated with COVID-19 infection but not symptoms after adjustment, with some evidence of an interaction between obesity and diabetes. Conclusion: While the limitations of this health system convenience sample include generalizability and selection around test seeking, the strong graded association of BMI and diabetes with self-reported COVID-19 infection suggests that obesity and diabetes may play a role in risk for symptomatic SARS-CoV-2 beyond co-occurrence with socioeconomic factors.