Why Should Obese Youth Be Prioritized in COVID-19 Vaccination Programs?

Background: The dominant effect of age on COVID-19 mortality obscures the impact of other risk factors. As age is often a covariate to be adjusted in multivariate analyses, the risk of COVID-19 mortality has not been specifically estimated for obese young individuals. This risk estimate is especially critical for prioritizing groups to receive COVID-19 vaccination. Methods: Starting with 1,120,767 unvaccinated individuals registered in a Brazilian surveillance system, we selected 313,898 hospitalized COVID-19 patients aged 20 to 89 who had a BMI ≥ 25 kg/m 2 and cardiovascular diseases (CVD) or diabetes. We also selected individuals with no risk factors associated with severe COVID-19. We stratified the patients by age, obesity, BMI, and comorbidities. Subsequently, we applied crude and adjusted odds ratio, hazard ratio, and Kaplan–Meier curves using invasive and non-invasive ventilatory support, intensive care unit (ICU) admission, and death as disease outcomes. Findings: Obesity alone is a risk factor for in-hospital mortality and is more significant than cardiovascular disease and diabetes. Furthermore, obesity, cardiovascular disease, and diabetes increase the risk of severity and death by COVID-19 more significantly in young adults than in the elderly. When categorizing patients by obesity classes, the severity of obesity was found to be associated with a higher risk of admission to the ICU and death from COVID-19 than the non-obese young adults or elderly population. Interpretation: Our findings highlight the importance of prioritizing obese young in vaccination campaigns against COVID-19. Fundings: This work was supported by the Brazilian National Council for Scientific and Technological Development (grant number 313662/2017-7 and 307356/2017-5; the Sao Paulo Research Foundation (grant numbers 2018/14933-2; 2020/04836-0); and CAPES. Declaration of Interest: None to declare.