Opioid use disorder and health service utilization among COVID-19 patients in the US: A nationwide cohort from the Cerner Real-World Data

Abstract

Background: Both opioid use and COVID-19 affect respiratory and pulmonary health, potentially putting individuals with opioid use disorders (OUD) at risk for complications from COVID-19. We examine the relationship between OUD and subsequent hospitalization, length of stay, risk for invasive ventilator dependence (IVD), and COVID-19 mortality. Methods: Multivariable logistic and exponential regression models using electronic health records data from the Cerner COVID-19 De-Identified Data Cohort from January through June 2020. Findings: Out of 52,312 patients with COVID-19, 1.9% (n=1,013) had an OUD. COVID-19 patients with an OUD had higher odds of hospitalization (aOR=3.44, 95% CI=2.81À4.21), maximum length of stay (eb=1.16, 95% CI=1.09À1.22), and odds of IVD (aOR=1.26, 95% CI=1.06À1.49) than patients without an OUD, but did not differ with respect to COVID-19 mortality. However, OUD patients under age 45 exhibited greater COVID-19 mortality (aOR=3.23, 95% CI=1.59À6.56) compared to patients under age 45 without an OUD. OUD patients using opioid agonist treatment (OAT) exhibited higher odds of hospitalization (aOR=5.14, 95% CI=2.75À10.60) and higher maximum length of stay (eb=1.22, 95% CI=1.01À1.48) than patients without OUDs; however, risk for IVD and COVID-19 mortality did not differ. OUD patients using naltrexone had higher odds of hospitalization (aOR=32.19, 95% CI=4.29À4,119.83), higher maximum length of stay (eb=1.59, 95% CI=1.06À2.38), and higher odds of IVD (aOR=3.15, 95% CI=1.04À9.51) than patients without OUDs, but mortality did not differ. OUD patients who did not use treatment medication had higher odds of hospitalization (aOR=4.05, 95% CI=3.32À4.98), higher maximum length of stay (eb=1.14, 95% CI=1.08À1.21), and higher odds of IVD (aOR=1.25, 95% CI=1.04À1.50) and COVID-19 mortality (aOR=1.31, 95% CI=1.07À1.61) than patients without OUDs. Interpretation: This study suggests people with OUD and COVID-19 often require higher levels of care, and OUD patients who are younger or not using medication treatment for OUDs are particularly vulnerable to death due to COVID-19.

Opioid usage and COVID-19 prognosis: A systematic review and meta-analysis

“…A full text review of the remaining 52 studies was then conducted, and 47 records were eliminated since they were reviews, abstract, letters, conferences, without comparison between opioid use and no-opioid use, or without clinical outcomes reported. Therefore, a total of 5 studies with 1,023,224 patients were included in the final analysis [ [22] , [23] , [24] , [25] , [26] ]. The process of study retrieval is shown in Fig.…”

“… Study Region Opioid No opioid Study design Sample size Definition of opioid Adjusted variables NOS score Age Male (%) Age Male (%) Allen [ 22 ] 2020 U.S.A NR NR NR NR Retrospective cohort 11,830 ICD-10 codes F11 (opioid use disorder) Sex, age, race and comorbidity 8 Oh [ 23 ] 2021 South Korea NR NR NR NR Retrospective cohort 7713 All opiates except codeine, dihydrocodeine, hydrocodone, and tramadol. Sex, age, race, annual income level in 2020 and comorbidity 8 Qeadan [ 24 ] 2021 U.S.A 60 (48–70) 502 (49.6) 53 (35–68) 25,298 (49.3) Retrospective cohort 52,312 Measured by past opioid overdose or opioid use disorders recorded in ICD-9 or ICD-10 codes Age, gender, race/ethnicity, insurance, region, diabetes mellitus, asthma, hypertension, hydroxychloroquine, remdesivir, decadron or prednisone, aspirin and plavix 8 Tuan [ 25 ] 2021 U.S.A 52.1 ± 17.1 3764 (39.4) 43.1 ± 17.6 199,947 (48.9) Retrospective cohort 418,216 Individuals are prescribed with opioids in three or more consecutive months or at least 90 days at outpatient settings. Age, sex, race/ethnicity and comorbidities (diabetes, essential hypertension, chronic pulmonary conditions, cardiovascular diseases, mental health disorders) 8 Wiener [ 26 ] 2021 U.S.A 71.8 ± 6.3 3382 (45.1) 74.1 ± 7.3 245,186 (46.9) Retrospective cohort 533,153 The unhealthf...…”

Experiences with and impacts of the COVID-19 pandemic by substance use disorder in the early phase of pandemic in the United States: A cross-sectional survey, 2020

“…We conducted one of the first nationally representative studies focused on associations between SUD and COVID-19 experiences in the U.S. We found that individuals with a SUD had decreased odds of having access to paid sick leave and increased odds of being laid off from work due to the pandemic. Recent studies have found that individuals with an SUD were at increased risk for contracting COVID-19, and among those who contract COVID-19, those with SUDs have worse outcomes including higher risk of hospitalization and death [ 4 , 5 ]. The present study highlights important non-clinical impacts of the pandemic affecting individuals with SUD and point to structural inequities that can amplify the effects of the pandemic in this population.…”

“…Our covariates were selected a priori based on their association with COVID-19 and SUDs: gender [men/women], age [continuous], geographic region [Northeast, South, Southwest, West], and annual household income [<$40,000; $40,000-$99,999; $100,000+]. We also included insurance status [Employer-based, Government (Medicare/Medicaid/Veterans Health Administration) or marketplace, Other, or None] based on recent findings that the relationship between having an opioid use disorder and COVID-19 related outcomes varied by insurance status [ 4 ]. These items were modified versions of questions used in the American Community Survey or America National Election Studies.…”

“…Despite these concerns, very little data exist on COVID-19 testing and pandemic-related challenges among individuals with a SUD [ 4 , 5 ]. In the current study, we surveyed a nationally representative sample of adults in the United States (U.S.) in the early stages of the pandemic to explore differences between individuals with and without a SUD with regard to: underlying health conditions that exacerbate COVID-19 morbidity, COVID-19 testing, available paid sick leave, and loss of employment.…”