# The association between non-communicable diseases and COVID-19 severity and mortality among infected hospitalized healthcare workers in 29 countries: a cohort study

## TL;DR

Healthcare workers with non-communicable diseases like obesity and diabetes are at higher risk of severe illness and death from COVID-19.

## Contribution

This study identifies obesity and diabetes as major risk factors for severe outcomes in healthcare workers with COVID-19.

## Key findings

- Obesity and diabetes mellitus were the leading risk factors for severe and fatal outcomes in healthcare workers with COVID-19.
- Approximately 10.68% of healthcare workers with confirmed COVID-19 died, with higher mortality linked to non-communicable diseases.
- Reducing obesity and diabetes prevalence could significantly lower the risk of severe illness and death from COVID-19 among healthcare workers.

## Abstract

Due to occupational exposure, healthcare workers (HCWs) have a higher risk of Coronavirus Disease 2019(COVID-19) infection than the general population. Non-communicable diseases (NCDs) may increase the risk of COVID-19-related morbidity and mortality among HCWs, potentially reducing the available health workforce. We examined the association between NCDs and COVID-19 disease severity and mortality among infected HCWs.

This cohort study used data from the International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) database. HCWs hospitalized between January 2020 and January 2023 due to clinically suspected or laboratory-confirmed COVID-19 were eligible for inclusion. Variables collected included demographic data, comorbidities, and hospitalization outcomes. Descriptive statistics were reported using mean/standard deviation (SD), median/interquartile range (IQR), or frequencies and proportions. For each NCD, the relative risk of death, adjusted for age and sex, was calculated using log-binomial regression as well as the population-attributable fraction.

There were 17,502 HCWs, 95.7% of whom had a confirmed COVID-19 diagnosis. The majority were female (66.5%) and the mean age (SD) was 49.8 (14.3) years. Roughly, half (51.42%) of HCWs had no comorbidities, 29.28% had one comorbidity, 14.68% had 2 comorbidities and <5% had ≥3 comorbidities. The most common comorbidities were diabetes mellitus (49.40%) and cardiovascular disease (36.90%). Approximately one-fifth of the HCWs had severe COVID-19 (16.95%) and 10.68% of the HCWs with COVID-19 died. Being ≥45 years old, male gender, smoking, obesity, and certain NCDs increased the risk of COVID-19 severity and mortality. Obesity and diabetes mellitus were the leading risk factors in terms of the population-attributable risk for COVID-19 severity (6.89%) and mortality (36.00%) respectively.

Many HCWs with COVID-19 had one or more NCDs. Obesity and diabetes mellitus increased COVID-19 severity and mortality risk. Reducing the prevalence of obesity and diabetes mellitus would yield the biggest reduction in COVID-19-related morbidity and mortality among HCWs.