The association of obesity and other metabolic disorders with COVID-19 mortality: a cross-sectional analysis of death certificates from Veneto (Italy) and Bavaria (Germany).

BACKGROUND AND AIM: The study investigates mortality related to obesity and other metabolic disorders during the pandemic, comparing findings from two large European regions.

METHODS AND

RESULTS

All death certificates of residents aged 45-84 years in Veneto (Italy) and Bavaria (Germany) were extracted from January 2020 to December 2022. The proportion of deaths reporting obesity, diabetes, and hypertension was computed both for all-cause and for COVID-19 deaths. The prevalence of mention of metabolic disorders was compared between deaths attributed to COVID-19 and all other deaths by means of Odds Ratios (OR) with 95 % Confidence Intervals (CI) estimated by conditional logistic regression stratified by age, sex, and year of death. Overall 81,125 deaths in Veneto (8.5 % attributed to COVID-19) and 253,862 in Bavaria (5.9 % from COVID-19) were investigated. At least one metabolic disorder was mentioned in 35.8 % of all COVID-19 deaths in Veneto and 26.7 % in Bavaria. Obesity-related deaths sharply peaked in each epidemic wave in both regions, with a less marked pattern for hypertensive diseases and diabetes. The association with COVID-19 increased with the number of reported metabolic disorders, was stronger among younger ages and in Veneto. Estimated OR for COVID-19 death among decedents aged 45-64 years with two/three vs. no metabolic disorder were 4.24 (CI 3.33-5.40) in Veneto and 2.14 (1.83-2.51) in Bavaria.

CONCLUSION

The strong association between deaths from COVID-19 and number of metabolic disorders among younger ages highlights the need for prioritizing preventive interventions for obesity and associated metabolic conditions.