The Interplay between Excess Weight, Socioeconomic Status, and Risk for SARS-CoV-2 Infection

Introduction:
Multiple studies show a high proportion of obesity among confirmed cases of SARS-CoV-2 infection and recent studies have suggested higher rates of infection in low socio-economic status (SES). The interplay between SES and obesity as risk factors for infection is unknown.

Aim:
Our goal was to investigate the interaction between obesity and SES as risk factors for SARS-CoV-2 susceptibility when the alpha variant was dominant.

Methods:
We designed a cross-sectional study of subjects with available BMI measurements and a SARS-CoV-2 PCR test results, presenting to the emergency department at the Sheba Medical Center between March 16 and November 15 2020.

Results:
The odds of testing positive for SARS-CoV-2 in subjects with overweight (BMI 25.0-29.9 kg/m2) as compared to subjects with normal weight (BMI 18.5-24.9 kg/m2) were significantly higher (OR = 1.46, 95% CI 1.12 - 1.92) and this relationship remained significant after adjusting for age, gender, SES and population density. For every 1-unit increment in SES, the odds for positive test results decreased by 0.83 (95% CI: 0.78-0.88). In addition, we found that the probability of testing positive for SARS-CoV-2 with every 1 kg/m2 increment in BMI was significantly higher only for subjects of low SES after adjusting for the above confounders.

Conclusion:
Our analysis shows the interplay between excess weight and sociodemographic measures where higher BMI did not increase the risk for SARS-CoV-2 infection in high SES groups, but when superimposed on low-SES it was associated with a markedly increased risk.