Association between Body Mass Index and Risk of Coronavirus Disease 2019 (COVID-19): A Nationwide Case-control Study in South Korea

Clin Infect Dis. 2021 Oct 5;73(7):e1855-e1862. doi: 10.1093/cid/ciaa1257.


Background: Increased body mass index (BMI) has been associated with a higher risk of severe coronavirus disease 2019 (COVID-19) infections. However, whether obesity is a risk factor for contracting COVID-19 has hardly been investigated so far.

Methods: We examined the association between BMI level and the risk of COVID-19 infection in a nationwide case-control study comprised of 3788 case patients confirmed to have COVID-19 between 24 January and 9 April 2020 and 15 152 controls matched by age and sex, who were aged 20 years or more and underwent National Health Insurance Service (NHIS) health examinations between 2015-2017, using data from the Korean NHIS with linkage to the Korea Centers for Disease Control and Prevention data. Our primary exposure of interest was BMI level, categorized into 4 groups: <18.5 (underweight), 18.5-22.9 (normal weight), 23-24.9 (overweight), and ≥25 kg/m2 (obese).

Results: Of the entire 18 940 study participants, 11 755 (62.1%) were women, and the mean age of the study participants was 53.7 years (standard deviation, 13.8). In multivariable logistic regression models adjusted for sociodemographic, comorbidity, laboratory, and medication data, there was a graded association between higher BMI levels and higher risk of COVID-19 infection. Compared to normal-weight individuals, the adjusted odds ratios in the overweight and obese individuals were 1.13 (95% confidence interval [CI], 1.03-1.25) and 1.26 (95% CI, 1.15-1.39), respectively. This association was robust across age and sex subgroups.

Conclusions: Higher BMI levels were associated with a higher risk of contracting COVID-19.

Keywords: COVID-19; SARS-COV-2; body mass index; obesity.

MeSH terms

  • Adult
  • Body Mass Index
  • COVID-19*
  • Case-Control Studies
  • Female
  • Humans
  • Middle Aged
  • Republic of Korea / epidemiology
  • Risk Factors
  • SARS-CoV-2
  • Young Adult