COVID19 data from NHIS
Breakthrough SARS-CoV-2 infections of vaccinated individuals are being reported globally, resulting in an increased risk of hospitalization and death among such patients. Therefore, it is crucial to identify the modifiable risk factors that may affect the protective efficacy of vaccine use against the development of severe COVID-19 and thus to initiate early medical interventions. Here, in population-based studies using the UK Biobank database and the 2021 National Health Interview Survey (NHIS), we analyzed 20,362 participants aged 50 years or older and 2,588 aged 18 years or older from both databases who tested positive for SARS-COV-2, of whom 33.1% and 67.7% received one or more doses of vaccine, respectively. In the UK Biobank, participants are followed from the vaccination date until Oct. 18, 2021. We found that obesity and metabolic abnormalities (namely, hyperglycemia, hyperlipidemia and hypertension) were modifiable factors for severe COVID-19 in vaccinated patients (All P < .05). When metabolic abnormalities were present, regardless of obesity, the risk of severe COVID-19 was higher than that of metabolically normal individuals (All P < .05). Moreover, pharmacological interventions targeting such abnormalities (namely, antihypertensive (adjusted hazard ratio (aHR) .64, 95% CI .48-.86; P = .003), glucose-lowering (aHR .55, 95% CI .36-.83; P = .004) and lipid-lowering treatments (aHR .50, 95% CI .37-.68; P < .001)) were significantly associated with a reduced risk for this outcome. These results show that more proactive health management of patients with obesity and metabolic abnormalities is critical to reduce the incidence of severe COVID-19 after vaccination. To further observe the impact of obesity and metabolic abnormalities on the risk of severe COVID-19-related events from different populations, data from the 2021 National Health Interview Survey were used for the current study (https://www.cdc.gov/nchs/nhis/2021nhis.htm). The study design based on NHIS data was a cross-sectional study. The NHIS is a nationally representative household survey of the non-hospitalized population in the United States and is conducted continuously throughout the year by the National Center for Health Statistics (NCHS). The main objective of the NHIS is to monitor the health of the United States population through the collection and analysis of data on a broad range of health topics. In the 2021 NHIS survey, detailed information about COVID-19 was collected, including vaccination status, SARS-CoV-2 infection status, and severity of COVID-19 symptoms.
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In the cross-section study based on data from 2021NHIS, we aim to assess the association of metabolic obesity phenotypes with severe COVID-19 symptoms in vaccinated and unvaccinated populations. Logistic regression models were used to analyze the association between exposure and severe COVID-19 symptoms, adjusting for covariates age, sex, smoking status, vaccine dose, comorbidities (COPD, ischemic heart disease, liver cirrhosis, CKD, osteoarthritis, asthma, dementia, mania bipolar disorder depression, and immunodeficiency). Statistical analyses were performed using R version 4.0.2 (R Foundation for Statistical Computing, Vienna, Austria) and Stata version 16.0 (Stata Corp., College Station, Texas, USA). Statistical significance was indicated by 95% confidence intervals (CIs) not containing the null or a two tailed test with P < .05.