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

Obesity has been associated with worse outcomes in patients with COVID-19 infection, but nationally representative data across multiple pandemic years remain limited. We conducted a retrospective cohort study using the National Inpatient Sample database from 2020 to 2022 to evaluate the association between obesity and in-hospital outcomes among adults hospitalized with COVID-19 in the United States. Adult hospitalizations with COVID-19 infection were identified and stratified according to the presence or absence of obesity. Multivariable regression analyses were performed to assess the association of obesity with in-hospital mortality, respiratory support, renal complications, thromboembolic events, sepsis-related outcomes, cardiovascular complications, hospital length of stay, total hospitalization charges, and discharge disposition. A total of 5,934,565 adult COVID-19 hospitalizations were included, of which 1,450,164 patients had obesity, and 4,484,401 did not. Patients with obesity were younger, more likely to be female, and more commonly African American or Hispanic. After multivariable adjustment, obesity was associated with increased odds of mortality (aOR, 1.27; 95% CI, 1.25–1.29; p < 0.001), respiratory support, vasopressor use, sepsis, septic shock, acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO), acute pulmonary embolism, acute deep venous thrombosis, tracheostomy, acute kidney injury, and renal replacement therapy, along with longer hospital stays and higher total hospitalization charges. Mortality among patients with obesity peaked in 2021 and declined in 2022. Obesity appears to be an independent predictor of adverse in-hospital outcomes in adults hospitalized with COVID-19.