COVID19 data from NHIS

Breakthrough SARS-CoV-2 infections of vaccinated individuals are being reported globally, resulting in an increased risk of hospitalization and death among such patients. Therefore, it is crucial to identify the modifiable risk factors that may affect the protective efficacy of vaccine use against the development of severe COVID-19 and thus to initiate early medical interventions. Here, in population-based studies using the UK Biobank database and the 2021 National Health Interview Survey (NHIS), we analyzed 20,362 participants aged 50 years or older and 2,588 aged 18 years or older from both databases who tested positive for SARS-COV-2, of whom 33.1% and 67.7% received one or more doses of vaccine, respectively. In the UK Biobank, participants are followed from the vaccination date until Oct. 18, 2021. We found that obesity and metabolic abnormalities (namely, hyperglycemia, hyperlipidemia and hypertension) were modifiable factors for severe COVID-19 in vaccinated patients (All P < .05). When metabolic abnormalities were present, regardless of obesity, the risk of severe COVID-19 was higher than that of metabolically normal individuals (All P < .05). Moreover, pharmacological interventions targeting such abnormalities (namely, antihypertensive (adjusted hazard ratio (aHR) .64, 95% CI .48-.86; P = .003), glucose-lowering (aHR .55, 95% CI .36-.83; P = .004) and lipid-lowering treatments (aHR .50, 95% CI .37-.68; P < .001)) were significantly associated with a reduced risk for this outcome. These results show that more proactive health management of patients with obesity and metabolic abnormalities is critical to reduce the incidence of severe COVID-19 after vaccination. To further observe the impact of obesity and metabolic abnormalities on the risk of severe COVID-19-related events from different populations, data from the 2021 National Health Interview Survey were used for the current study (https://www.cdc.gov/nchs/nhis/2021nhis.htm). The study design based on NHIS data was a cross-sectional study. The NHIS is a nationally representative household survey of the non-hospitalized population in the United States and is conducted continuously throughout the year by the National Center for Health Statistics (NCHS). The main objective of the NHIS is to monitor the health of the United States population through the collection and analysis of data on a broad range of health topics. In the 2021 NHIS survey, detailed information about COVID-19 was collected, including vaccination status, SARS-CoV-2 infection status, and severity of COVID-19 symptoms.全球范围内已有接种疫苗个体发生严重急性呼吸综合征冠状病毒2（SARS-CoV-2）突破性感染的报道，此类患者的住院与死亡风险均有所升高。因此，明确可影响疫苗针对重型新型冠状病毒肺炎（COVID-19）的保护效力的可改变危险因素，进而启动早期医学干预，至关重要。 本研究依托英国生物样本库（UK Biobank）与2021年全国健康访谈调查（National Health Interview Survey, NHIS）开展人群研究，共纳入两个数据库中20362名50岁及以上、2588名18岁及以上的SARS-CoV-2核酸检测阳性参与者，其中分别有33.1%与67.7%的人群完成了至少1剂疫苗接种。在英国生物样本库队列中，研究随访从参与者接种疫苗之日起至2021年10月18日止。 分析结果显示，肥胖与代谢异常（即高血糖、高脂血症与高血压）是接种疫苗后感染SARS-CoV-2患者发生重型COVID-19的可改变危险因素（所有P < 0.05）。当存在代谢异常时，无论是否合并肥胖，患者发生重型COVID-19的风险均显著高于代谢正常个体（所有P < 0.05）。此外，针对此类代谢异常的药物干预措施——包括降压治疗（调整后风险比（adjusted hazard ratio, aHR）= 0.64，95%置信区间（confidence interval, CI）：0.48~0.86；P = 0.003）、降糖治疗（aHR = 0.55，95%CI：0.36~0.83；P = 0.004）与调脂治疗（aHR = 0.50，95%CI：0.37~0.68；P < 0.001）——均与该不良结局的风险降低存在显著相关性。本研究结果表明，对合并肥胖与代谢异常的患者实施更积极的健康管理，对于降低接种疫苗后重型COVID-19的发病率具有关键意义。 为进一步探究不同人群中肥胖与代谢异常对重型COVID-19相关事件风险的影响，本研究使用了2021年NHIS的数据（https://www.cdc.gov/nchs/nhis/2021nhis.htm）。基于NHIS数据的研究设计为横断面研究。NHIS是由美国国家卫生统计中心（National Center for Health Statistics, NCHS）全年持续开展的、针对美国非住院人群的全国代表性家庭调查。该调查的核心目标是通过收集与分析涵盖广泛健康主题的数据，监测美国人群的健康状况。在2021年NHIS调查中，研究人员收集了关于COVID-19的详细信息，包括疫苗接种状态、SARS-CoV-2感染状态以及COVID-19症状严重程度。