Reducing COVID-19 hospitalization risk through behavior change

Our objective was to determine strategies that could potentially reduce the risk of hospitalizations from COVID-19 due to underlying conditions. We used data (N=444,649) from the 2017 Behavioral Risk Factor Surveillance System to identify potentially modifiable risk factors associated with reporting any of the underlying conditions (cardiovascular disease, asthma, chronic obstructive pulmonary disease, diabetes, hypertension or obesity) found to increase risk of US hospitalizations for COVID-19. Risk factors included lifetime smoking, sedentary lifestyle, and inadequate fruit and vegetable consumption. Multiple logistic regression in Stata produced adjusted odds ratios (AORs) used to estimate population attributable-risk (PAR) in Excel. PARs for the 3 risk factors ranged from 12.4% for inactivity to 15.6% for diet for a combined PAR of 36.3%, implying that total elimination of these 3 risk factors could potentially reduce underlying conditions as much as 36%. This suggests that reducing COVID-19 hospitalizations might be a measurable and feasible US goal for the coronavirus pandemic. The simple lifestyle changes of increasing physical activity and fruit and vegetable consumption could reduce obesity, a key underlying condition and risk factor for 4 others. Reducing obesity and inactivity may also boost immunity. With uncertainly around how long the pandemic might last, other proposed strategies include wearing face masks when social distancing is not feasible, and addressing the special issues for nursing home residents. Such actions have the potential to lessen the impact of COVID-19 in the short term along with providing long term health benefits regarding chronic conditions.