Coronavirus disease 2019 hospitalizations attributable to cardiometabolic conditions in the united states: A comparative risk assessment analysis

BACKGROUND: Risk of coronavirus disease 2019 (COVID-19) hospitalization is robustly linked to cardiometabolic health. We estimated the absolute and proportional COVID-19 hospitalizations in US adults attributable to 4 major US cardiometabolic conditions, separately and jointly, and by race/ethnicity, age, and sex. METHODS AND RESULTS: We used the best available estimates of independent associations of cardiometabolic conditions with a risk of COVID-19 hospitalization; nationally representative data on cardiometabolic conditions from the National Health and Nutrition Examination Survey 2015 to 2018; and US COVID-19 hospitalizations stratified by age, sex, and race/ethnicity from the Centers for Disease Control and Prevention’s Coronavirus Disease 2019–Associated Hospitalization Surveillance Network database and from the COVID Tracking Project to estimate the numbers and proportions of COVID-19 hospitalizations attributable to diabetes mellitus, obesity, hypertension, and heart failure. Inputs were combined in a comparative risk assessment framework, with probabilistic sensitivity analyses and 1000 Monte Carlo simulations to jointly incorporate stratum-specific un-certainties in data inputs. As of November 18, 2020, an estimated 906 849 COVID-19 hospitalizations occurred in US adults. Of these, an estimated 20.5% (95% uncertainty interval [UIs], 18.9–22.1) of COVID-19 hospitalizations were attributable to diabetes mellitus, 30.2% (UI, 28.2–32.3) to total obesity (body mass index ≥30 kg/m²), 26.2% (UI, 24.3–28.3) to hypertension, and 11.7% (UI, 9.5–14.1) to heart failure. Considered jointly, 63.5% (UI, 61.6–65.4) or 575 419 (UI, 559 072–593 412) of COVID-19 hospitalizations were attributable to these 4 conditions. Large differences were seen in proportions of cardiometabolic risk– attributable COVID-19 hospitalizations by age and race/ethnicity, with smaller differences by sex. CONCLUSIONS: A substantial proportion of US COVID-19 hospitalizations appear attributable to major cardiometabolic condi-tions. These results can help inform public health prevention strategies to reduce COVID-19 healthcare burdens.