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Higher body mass index (BMI) has been associated with a higher risk for severe COVID-19 outcomes. The aim of this study was to investigate associations among BMI, underlying health conditions and hospital admission as well as the effects of COVID-19 vaccines in adults aged 50 years and older in Europe using data from the Survey of Health, Ageing and Retirement in Europe (SHARE) which was collected from June to August 2021, shortly after the second wave of the COVID-19 pandemic occurred in Europe. Survey data totalling 1936 individuals were used for statistical analyses to calculate the likelihood of hospitalization due to COVID-19 infection in relation to BMI, sociodemographic factors, comorbidities and COVID vaccination status. Approximately 16% of individuals testing positive for COVID-19 were hospitalized for COVID-19, and over 75% of these hospitalized individuals were either overweight or obese. The likelihood of hospitalization for individuals with obesity was approximately 1.5 times (CI [1.05–2.05]) higher than those with a healthy weight (BMI = 18.5–24.9 kg/m2) after adjusting for BMI, sex and age. After adjusting for sociodemographic factors, vaccination and comorbidities, the likelihood of hospitalization for individuals with obesity was 1.34 times higher than those with a healthy weight (CI [0.94–1.90]). Vaccine uptake was lowest in individuals with obesity (BMI ≥ 30 kg/m2) in all age groups. Individuals who had not received a vaccine were 1.8 times more likely to be hospitalized (CI [1.34–2.30]). Across European regions, obesity is associated with higher odds of hospitalization, and vaccination may be effective to reduce these odds for older adults.

When evaluating vaccine efficacy, the conventional measures include reduction of risk of hospitalization and death. The number of patients dying with or without vaccination is often in the public spotlight. However, when evaluating public health interventions or the burden of disease, it is more illustrative to use mortality metrics taking into account also prematurity of the deaths, such as years of life lost (YLL) or years of life saved (YLS) thanks to the vaccination. We develop this approach for evaluation of the difference in YLL and YLS between COVID-19 victims with or without completed vaccination in the autumn pandemic wave (2021, October–December) in Czechia. For the analysis, individual data about all COVID-19 deaths in the country (N = 5797, during the studied period) was used. While 40.6% of the deaths are in cohorts with completed vaccination, this corresponds to 35.1% of years of life lost. The role of vaccination is expressed using YLS and hypothetical numbers of deaths. The registered number of deaths is approximately 3.5 times lower than it would be expected without vaccination. The results illustrate that vaccination is more effective in saving lives than suggested by simplistic comparisons.