Extreme obesity associated with higher risk of death for 2009 H1N1 patients

[EMBARGOED FOR JAN. 5, 2011] For those infected with the 2009 pandemic influenza A (H1N1) virus, extreme obesity was a powerful risk factor for death, according to an analysis of a public health surveillance database. In a study to be published in the February 1, 2011, issue of Clinical Infectious Diseases, researchers associated extreme obesity with a nearly three-fold increased odds of death from 2009 H1N1 influenza. Half of Californians greater than 20 years of age hospitalized with 2009 H1N1 were obese. (Please see below for a link to the study online.)

Data from 500 adults hospitalized with H1N1 in the first four months of 2009 in California were analyzed to test the hypothesis of obesity as a risk factor for increased fatality. Extreme obesity is defined as having a body mass index (BMI) equal to or over 40. The data was collected April 20 – Aug. 11, 2009, by health providers and reported to local health departments, which subsequently provided the data to the California Department of Public Health. During this period, H1N1 accounted for 50 percent of influenza-like illnesses. Patients under 20 years of age and pregnant patients were excluded from the study.

"Extremely obese persons with a body mass index equal to or over 40 should get vaccinated annually for influenza," according to study author Janice K. Louie, MD, MPH, of the California Department of Public Health. "They should also see their health provider early if symptoms of influenza develop, so that they can get diagnosed and treated as quickly as possible. This is especially important if the influenza virus is known to be circulating in the community and causing illness." Dr. Louie stressed that more research is needed to understand why extremely obese people are more likely to die from the 2009 H1N1 influenza infection.

NOTE: The study is available online. It is embargoed until 12:01 a.m. EST on Wednesday, Jan. 5, 2011:

"A Novel Risk Factor for a Novel Virus: Obesity and 2009 Pandemic Influenza A (H1N1)" http://www.oxfordjournals.org/our_journals/cid/ciq152.pdf

Founded in 1979, Clinical Infectious Diseases publishes clinical articles twice monthly in a variety of areas of infectious disease, and is one of the most highly regarded journals in this specialty. It is published under the auspices of the Infectious Diseases Society of America (IDSA). Based in Arlington, Va., IDSA is a professional society representing more than 9,000 physicians and scientists who specialize in infectious diseases. For more information, visit www.idsociety.org.

I'd like to see a better clue as to correlation of the weight AND age of these "over 20"...

I think they're trying to "stress" obesity when perhaps age is the better correlation.

In other words, they want the old AND obese in line for flu shots. They reserved these shots for the young at first.

Next time around, you will be FORCED to get the shot.

I’ll bet they were probably older, too.

You get fatter as you get older. Until you hit about 60, I guess.

40 year olds are fatter than 30 year olds are fatter than 20 year olds.

But it’s the fashion to criticize the fat right now, fat according to CDC standards, so play on.

Here's the abstract. It's 12 pages long.

Background. Many critically ill patients with 2009 pandemic influenza A (H1N1) (2009 H1N1) infection were noted to be obese, but whether obesity, rather than its associated co-morbidities, is an independent risk factor for severe infection is unknown.

Methods. Using public health surveillance data, we analyzed demographic and clinical characteristics of California residents hospitalized with 2009 H1N1 infection to assess whether obesity (body mass index [BMI] >30) and extreme obesity (BMI >40) were an independent risk factor for death among case patients > 20 years old.

Results. During the period 20 April–11 August 2009, 534 adult case patients with 2009 H1N1 infection for whom BMI information was available were observed. Two hundred twenty-eight patients (43%) were >50 years of age, and 378 (72%) had influenza-related high-risk conditions recognized by the Advisory Committee on Immunization Practices as risk factors for severe influenza. Two hundred and seventy-four (51%) had BMI >30, which is 2.2 times the prevalence of obesity among California adults (23%) and 1.5 times the prevalence among the general population of the United States (33%). Of the 92 case patients who died (17%), 56 (61%) had BMI >30 and 28 (30%) had BMI>40. In multivariate analysis, BMI>40 (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.4– 5.9) and BMI >45 (OR, 4.2; 95% CI, 1.9–9.4), age >50 years (OR, 2.1; 95% CI, 1.2–3.7), miscellaneous immunosuppressive conditions (OR, 3.9; 95% CI, 1.6–9.5), and asthma (OR, 0.5; 95% CI, 0.3–0.9) were associated with death.

Conclusion. Half of Californians >20 years of age hospitalized with 2009 H1N1 infection were obese. Extreme obesity was associated with increased odds of death. Obese adults with 2009 H1N1 infection should be treated promptly and considered in prioritization of vaccine and antiviral medications during shortages.

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