Clinical Outcomes and Hospital Resource Utilization Among Hospitalized Patients with Obesity and COVID-19 Infection: Insights from United States National Inpatient Sample, 2020–2022

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Abstract
Background: Obesity has been associated with adverse COVID-19 outcomes, but nationally representative data across multiple pandemic years remain limited. We evaluated the association between obesity and in-hospital outcomes among adults hospitalized with COVID-19 infection in the United States during 2020–2022. Methods: We conducted a retrospective cohort study using the National Inpatient Sample. Adult COVID-19 hospitalizations were categorized according to obesity status. Survey-weighted multivariable regression analyses assessed associations with in-hospital mortality, respiratory support, renal complications, thromboembolic events, sepsis-related outcomes, cardiovascular complications, length of stay, hospitalization charges, and discharge disposition. Results: The study included 1,186,914 COVID-19 hospitalizations, representing 5,934,565 weighted hospitalizations of which 1,529,022 had obesity and 4,406,543 did not have obesity. Hospitalizations with obesity involved younger individuals and greater proportions of female individuals.After adjustment, obesity was associated with increased odds of mortality (adjusted odds ratio, 1.38; 95% confidence interval, 1.36–1.40; p < 0.001), mechanical ventilation, vasopressor use, sepsis, septic shock, acute respiratory distress syndrome, extracorporeal membrane oxygenation, acute pulmonary embolism, venous embolism and thrombosis, tracheostomy, acute kidney injury, and renal replacement therapy. Obesity was also associated with longer hospital stays and higher hospitalization charges. Mortality among hospitalizations with obesity peaked in 2021 and declined in 2022. Conclusions: Obesity was independently associated with adverse clinical outcomes and greater hospital resource utilization among adults hospitalized with COVID-19 infection.

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