Prevalence and impact of metabolically healthy obesity on cardiovascular outcomes in postmenopausal women and disparities: An age-matched study

Table 1 Baseline characteristics and comorbidities of metabolically healthy postmenopausal women (age ≥ 55years), 2020, n (%)

Baseline characteristics	With-out MHO, 148250 (50)	With MHO, 148250 (50)	Total	P value
Age in years at admission, median	65	65	65	1.000
Race				< 0.001
White	114615 (81.5)	111095 (78.6)	225710 (80.1)
Black	11865 (8.4)	16855 (11.9)	28720 (10.2)
Hispanic	10030 (7.1)	11415 (8.1)	21445 (7.6)
Asian/PI	3255 (2.3)	1040 (0.7)	4295 (1.5)
Native Americans	815 (0.6)	970 (0.7)	1785 (0.6)
Median household income national quartile for patient zip code				< 0.001
0-25	37800 (25.9)	41190 (28.2)	78990 (27.1)
26-50	39165 (26.9)	41120 (28.2)	80285 (27.5)
51-75	34980 (24)	36260 (24.8)	61190 (21)
76-100	33800 (23.2)	27390 (18.8)	61190 (21)
Payer type				< 0.001
Medicare	80025 (57.6)	83045 (59)	163070 (58.3)
Medicaid	15185 (10.9)	14130 (10)	29315 (10.5)
Private	43640 (31.4)	43555 (30.9)	87195 (31.2)
Elective				< 0.001
Non-elective	113055 (76.4)	110505 (74.6)	223560 (75.5)
Elective	35015 (23.6)	37610 (25.4)	72625 (24.5)
Weekend admission				0.021
Monday-Friday	119490 (80.6)	119990 (80.9)	239480 (80.8)
Saturday/Sunday	28755 (19.4)	28260 (19.1)	57015 (19.2)
Hospital location and teaching status				< 0.001
Rural	15075 (10.2)	13180 (8.9)	28255 (9.5)
Urban non-teaching	26875 (18.1)	28575 (19.3)	55450 (18.7)
Urban teaching	106300 (71.7)	106495 (71.8)	212795 (71.8)
Hospital region				< 0.001
Northeast	28845 (19.5)	28470 (19.2%)	57315 (19.3)
Midwest	30105 (20.3)	35610 (24)	65715 (22.2)
South	56840 (38.3)	54185 (36.5)	111025 (37.4)
West	32460 (21.9)	29985 (20.2)	62445 (21.1)
Comorbidities
Peripheral vascular disease	5340 (3.6)	6150 (4.1)	11490 (3.9)	< 0.001
Tobacco use disorder	32915 (22.2)	35455 (23.9)	68370 (23.1)	< 0.001
Alcohol abuse	7630 (5.1)	3625 (2.4)	11255 (3.8)	< 0.001
Drug abuse	5335 (3.6)	4065 (2.7)	9400 (3.2)	< 0.001
Cancer	22550 (15.2)	14095 (9.5)	36645 (12.4)	< 0.001
Chronic kidney disease	9315 (6.3)	15920 (10.7)	25235 (8.5)	< 0.001
Prior MI	2505 (1.7)	2990 (2)	5495 (1.9)	< 0.001
Prior PCI	170 (0.1)	210 (0.1)	380 (0.1)	0.040
Prior CABG	855 (0.6)	1090 (0.7)	1945 (0.7)	< 0.001
Heart failure	55 (0)	65 (0)	120 (0)	0.361
Prior venous thrombo-embolism	7670 (5.2)	11955 (8.1)	19625 (6.6)	< 0.001
Prior stroke/TIA	5305 (3.6)	4870 (3.3)	10175 (3.4)	< 0.001
Acquired immunodeficiency syndrome	570 (0.4)	415(0.3)	985 (0.3)	< 0.001
Depression	20870 (14.1)	25535 (17.2)	46405 (15.7)	< 0.001
Chronic pulmonary disease	32495 (21.9)	43225 (29.2)	75720 (25.5)	< 0.001
Hypothyroidism	24360 (16.4)	30655 (20.7)	55015 (18.6)	< 0.001
Other thyroid disorders	2705 (1.8)	2770 (1.9)	5475 (1.8)	0.375
Valvular disease	1235 (0.8)	1410 (1)	2645 (0.9)	0.001
Autoimmune conditions	7985 (5.4)	9150 (6.2)	17135 (5.8)	< 0.001
Obstructive sleep apnea	3570 (2.4)	20640 (13.9)	24210 (8.2)	< 0.001
COVID-19	7670 (5.2)	11810 (8)	19480 (6.6)	< 0.001
Bariatric surgery status	2515 (1.7)	7835 (5.3)	10350 (3.5)	< 0.001
Prior breast cancer	7690 (5.2)	6315 (4.3)	14005 (4.7)	< 0.001
Anxiety disorders	27420 (18.5)	27700 (18.7)	55120 (18.6)	0.186
Psychoses	4275 (2.9)	3420 (2.3)	7695 (2.6)	< 0.001
Dementia	8690 (5.9)	5425 (3.7)	14115 (4.8)	< 0.001
Prior cancer	19465 (13.1)	16140 (10.9)	35605 (12)	< 0.001
Outcome
MACCE	12385 (8.4)	11695 (7.9)	24080 (8.1)	< 0.001
Death during hospitalization	7385 (5)	6295 (4.2)	13680 (4.6)	< 0.001
Acute myocardial infarction	3750 (2.5)	4400 (3)	8150 (2.7)	< 0.001
Cardiac arrest	1595 (1.1)	1835 (1.2)	3430 (1.2)	< 0.001
Acute ischemic stroke	2035 (1.4)	1600 (1.1)	3635 (1.2)	< 0.001
Disposition of the patient				< 0.001
Routine	84060 (60.5)	77015 (54.6)	161075 (57.5)
Transfer to the short-term hospital	3270 (2.4)	3115 (2.2)	6385 (2.3)
Transfer other: SNF, ICF	22650 (16.3)	27575 (19.5)	50225 (17.9)
Home health care	28970 (20.8)	33345 (23.6)	62315 (22.3)
Length of the stay, days, median	3	4	3	< 0.001
Cost, United States dollar, median	44874.81	51497.44	48134.09	< 0.001

P < 0.05 indicates statistical significance. MHO: Metabolically healthy obesity; PI: Pacific islander; MI: Myocardial infarction; PCI: Percutaneous coronary intervention; CABG: Coronary artery bypass graft; TIA: Transient ischemic attack; COVID-19: Coronavirus disease 2019; MACCE: Major adverse cardiac and cerebral-vascular events; SNF: Skilled nursing facility; ICF: Intermediate care facility.

Table 2 Multivariable logistic regression odds of outcomes among hospitalized postmenopausal women with metabolically healthy obesity vs without metabolically healthy obesity and disparities

Outcome	Odds ratio	95%CI	P value
All-cause mortality	1.02	0.94-1.12	0.621
MACCE	1.08	1.01-1.16	0.028
MACCE (white)	1.05	0.97-1.13	0.243
MACCE (black)	1.23	1.01-1.49	0.035
MACCE (Hispanic)	1.19	0.93-1.53	0.175
MACCE (Asian/PI)	1.28	0.65-2.51	0.482
MACCE (Native American)	1.83	0.70-4.76	0.216
MACCE (median household income national quartile for patient zip code = 1)	1.10	0.97-1.25	0.149
MACCE (median household income national quartile for patient zip code = 4)	1.24	1.06-1.44	0.007
Effect modification by comorbidities and prior surgeries
MACCE (COVID-19 negative)	1.02	0.94-1.09	0.675
MACCE (COVID-19 positive)	1.59	1.29-1.96	< 0.001
MACCE (no history of bariatric surgery)	1.07		0.041
MACCE (history of bariatric surgery)	2.11		0.049
MACCE (no tobacco use disorder)	1.14	1.06-1.23	0.001
MACCE (tobacco use disorder)	0.85	0.72-0.99	0.039
MACCE (no depression)	1.07	0.99-1.15	0.080
MACCE (depression)	1.20	0.98-1.47	0.072

P < 0.05 indicates statistical significance. Multivariable regression models were adjusted for age at admission, median household income, race, payer type, elective and weekend admission, hospital location and teaching status, peripheral vascular disease, tobacco use disorder, alcohol abuse, drug abuse, cancer, chronic kidney disease, prior myocardial infarction, prior percutaneous coronary intervention, prior coronary artery bypass graft, heart failure, prior venous thrombo-embolism, prior transient ischemic attack/ stroke, acquired immunodeficiency syndrome, depression, chronic pulmonary disease, hypothyroidism, other thyroid disorders, valvular disease, auto-immune conditions, obstructive sleep apnea, coronavirus disease 2019, prior bariatric surgery, prior breast cancer, anxiety disorders, psychoses, dementia, prior cancer. MACCE: Major adverse cardiac and cerebral-vascular events; CI: Confidence intervals; COVID-19: Coronavirus disease 2019.

Table 3 Independent predictors of major adverse cardiac and cerebral-vascular events in postmenopausal women with metabolically healthy obesity

Predictors	Odds ratio	95%CI	P value
Median household income national quartile for zip code			< 0.001
1 vs 4	1.29	1.11-1.50
2 vs 4	1.21	1.04-1.40
3 vs 4	0.96	0.83-1.12
Race			0.116
Black vs white	1.14	0.99-1.31
Hispanic vs white	0.90	0.75-1.08
Asian/PI vs white	0.96	0.57-1.59
Native American vs white	1.37	0.84-2.23
Payer type			0.074
Medicaid vs Medicare	0.93	0.78-1.10
Private vs Medicare	0.87	0.76-0.99
Self-pay vs Medicare	0.70	0.52-0.95
No charge vs Medicare	1.22	0.48-3.11
Elective admission, non-elective vs elective	7.38	5.91-9.22	< 0.001
Weekend admission, Saturday/Sunday vs Monday-Friday	1.05	0.94-1.17	0.392
Hospital location and teaching status			< 0.001
Urban non-teaching vs rural	1.12	0.91-1.38
Urban teaching vs rural	1.44	1.20-1.72
Hospital region			< 0.001
Midwest vs northeast	0.68	0.58-0.81
South vs northeast	0.94	0.80-1.09
West vs northeast	0.99	0.84-1.17
Peripheral vascular disease	1.16	0.95-1.42	0.156
Prior MI	1.39	1.05-1.85	0.021
Prior PCI	1.39	0.52-3.74	0.509
Prior CABG	1.34	0.86-2.06	0.193
Prior TIA	0.52	0.39-0.71	< 0.001
Prior VTE	0.65	0.53-0.79	< 0.001
Chronic kidney disease	0.95	0.83-1.09	0.489
Acquired immunodeficiency syndrome	0.80	0.29-2.24	0.673
Alcohol abuse	0.95	0.70-1.29	0.737
Drug abuse	1.09	0.83-1.42	0.548
Chronic pulmonary disease	1.09	0.98-1.20	0.121
Hypothyroidism	0.72	0.64-0.81	< 0.001
Other thyroid disorders	1.02	0.72-1.44	0.904
Valvular disease	1.27	0.84-1.91	0.258
Autoimmune condition	0.95	0.78-1.15	0.574
Dementia	1.19	0.97-1.46	0.092
Obstructive sleep apnea	0.72	0.62-0.85	< 0.001
Prior breast cancer	0.70	0.54-0.90	0.006
Anxiety disorders	0.78	0.68-0.90	0.001
Psychoses	0.50	0.34-0.73	< 0.001
Bariatric surgery status	0.54	0.40-0.72	< 0.001
Tobacco use disorders	0.63	0.56-0.71	< 0.001
Depression	0.81	0.70-0.94	0.004
Age (at admission)	1.02	1.02-1.03	< 0.001

P < 0.05 indicates statistical significance. Multivariable regression models were adjusted for age at admission, median household income, race, payer type, elective and weekend admission, hospital location and teaching status, peripheral vascular disease, tobacco use disorder, alcohol abuse, drug abuse, cancer, chronic kidney disease, prior myocardial infarction, prior primary coronary intervention, prior coronary artery bypass graft, heart failure, prior venous thromboembolism, prior transient ischemic attack/stroke, acquired immunodeficiency syndrome, depression, chronic pulmonary disease, hypothyroidism, other thyroid disorders, valvular disease, auto-immune conditions, obstructive sleep apnea, coronavirus disease 2019, prior bariatric surgery, prior breast cancer, anxiety disorders, psychoses, dementia, prior cancer. CI: Confidence intervals; MI: Myocardial infarction; PCI: Primary coronary intervention; VTE: Venous thromboembolism; TIA: Transient ischemic attack; CABG: Coronary artery bypass graft.