Health-related Behaviors and Odds of COVID-19 Hospitalization in a Military Population

Bryant J. Webber, MD, MPH; Michael A. Lang, MD, MPH; David M. Stuever, PhD, MPH; James D. Escobar, MPH; Victoria F.H. Bylsma, MPH; Gregory G. Wolff, MPH


Prev Chronic Dis. 2021;18(11):e96 

In This Article

Abstract and Introduction


Introduction: Understanding the impact of behaviors on COVID-19 severity can improve health promotion strategies. We investigated the association between health-related behaviors and odds of hospitalization for COVID-19 in a cohort of military personnel.

Methods: This case-controlled study compared all active-duty US Air Force service members hospitalized for COVID-19 between March 5, 2020, and March 10, 2021 (cases), with their geographically matched peers who had COVID-19 and were treated as outpatients (controls). We used logistic regression to compare cases and controls according to self-reported sleep duration, physical activity, dietary factors, binge alcohol consumption, and tobacco use — with and without adjustment for sociodemographic factors, body mass index, physical fitness level, pertinent disease history, and psychological distress — resulting in crude and adjusted odds ratios (ORs) with 95% CIs. The trend between sugar-sweetened beverage (SSB) consumption and hospitalization odds was assessed by using the Cochran-Armitage test.

Results: Ninety-three hospitalized cases were matched to 372 ambulatory controls. Adjusting for baseline characteristics and other health-related behaviors, cases were more likely than controls to report fewer than 7 hours of sleep, compared with 7 to 9 hours (OR = 1.84; 95% CI, 1.07–3.16), and were more likely than controls to consume 3 or more SSBs per week, compared with fewer than 3 SSBs (OR = 1.74; 95% CI, 1.03–2.92). In a dose–response relationship, higher SSB consumption was associated with greater odds of being hospitalized (P value for trend = .02).

Conclusion: Interventions that address short sleep duration and SSB consumption may reduce morbidity from COVID-19 among military service members and potentially in the broader US population.


Several chronic conditions have been implicated in the development of severe COVID-19 illness, including obesity,[1,2] hypertension,[2] diabetes mellitus,[2] heart failure,[2] malignancy,[3] immunosuppression,[4] and hypovitaminosis D.[5] These conditions are causally or noncausally related to various health-related behaviors, some of which are independently associated with COVID-19 severity. For example, current and former smoking status is associated with disease progression,[6] and physical inactivity increases risk of hospitalization, intensive care unit admission, and mortality.[7,8]

Understanding the relationship between health-related behaviors and COVID-19 severity is important for guiding population-wide preventive strategies. We designed this study to determine whether short or long sleep duration, insufficient aerobic or strength-training activity, unhealthy dietary habits, binge alcohol consumption, tobacco use, and secondhand smoke exposure were associated with COVID-19 hospitalization in a military population. We chose this target population based on the potential national security ramifications of rampant illness, and the study affords a valuable opportunity for investigation due to availability of exposure and outcome data.