Risk factors for COVID-19 among persons with substance use disorder (PWSUD) with hospital visits – United States, April 2020–December 2020

Abstract

Introduction Sociodemographic factors and chronic conditions associated with coronavirus disease 2019 (COVID-19) among persons with substance use disorder (PWSUD) are not well understood. We identified risk factors associated with COVID-19 among PWSUD with hospital visits. Methods Using the Premier Healthcare Database Special COVID-19 Release, we conducted a case-control study using ICD-10-CM codes to identify PWSUD aged 12 years and older with hospital visits for any reason during April–December 2020. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) to identify factors associated with COVID-19 diagnosis among PWSUD (age, sex, race/ethnicity, U.S. Census Region, urban/rural classification, insurance payor type, comorbidities, and substance use disorder [SUD] type), and then stratified by SUD type. Results From April-December 2020, 18,298 (1.3%) of 1,429,154 persons with SUD in the database had a COVID-19 diagnosis. Among PWSUD, opioid use disorder (OUD; aOR=1.24, 95% CI=1.18-1.32), alcohol use disorder (AUD; aOR=1.16, 95%CI=1.11-1.22), cocaine or other stimulant use disorder (COUD; aOR=1.28, 95% CI=1.22-1.34), and multiple SUDs (aOR=1.20, 95%CI=1.15-1.26) were associated with higher odds of COVID-19, as were comorbidities such as chronic lower respiratory disease (aOR=1.32, 95% CI=1.26-1.37), chronic hepatitis (aOR=1.45, 95% CI=1.34-1.57), and diabetes (aOR=1.78, 95% CI=1.71-1.86). Conclusions Among a sample of PWSUD, OUD, AUD, COUD, multiple SUDs, and associated comorbidities were associated with COVID-19 diagnosis. Integration of COVID-related care, care of other comorbidities, and SUD treatment may benefit PWSUD. Future studies are needed to better understand COVID-19 prevention in this population and to reduce disparities among subpopulations at increased risk.

Hospitalization Associated With Comorbid Psychiatric and Substance Use Disorders Among Adults With COVID-19 Treated in US Emergency Departments From April 2020 to August 2021

“…Substance use disorder may also change the risk of acquiring COVID-19 and consequent hospitalization . People with SUD and an underlying medical condition are more likely to acquire COVID-19 and develop greater severity .…”

“…9 Substance use disorder may also change the risk of acquiring COVID-19 and consequent hospitalization. [9][10][11][12][13][14][15] People with SUD and an underlying medical condition are more likely to acquire COVID-19 12,13,15 and develop greater severity. 13 Patients with COVID-19 and opioid use disorder had up to 4 times the odds of hospitalization as those without it.…”

Methamphetamine use and adoption of preventive behaviors early in the COVID-19 pandemic among men who have sex with men in Los Angeles, California

“…Moreover, people with a substance use disorder exhibit increased risk of COVID-19 infection, experience substance related comorbidities (e.g. pulmonary damage, cardiomyopathy), and face access barriers due to social determinants of health that contribute to poorer outcomes ( Board et al, 2022 ; Volkow, 2020 ; Wang et al, 2021 ).…”

“…Since the start of the COVID-19 pandemic, there has been a dramatic rise in substance use, overdoses, and mental health challenges in the United States ( Czeisler et al, 2020 ), with MA use (and MA-fentanyl co-use) most commonly linked to overdoses in California, particularly in Los Angeles County ( Los Angeles County Department of Public Health and Substance Abuse Prevention and Control, 2021 ; Substance Abuse Prevention and Control (SAPC), 2020 ). In turn, large scale studies suggest those with a substance use disorder are increasingly susceptible to SARS-CoV-2 infection ( Board et al, 2022 ; Volkow, 2020 ; Wang et al, 2021 ).…”

Chronic alcohol consumption and COVID‐19 infection risk: A narrative review

“…In particular for smoking, there is enhanced likelihood of severe COVID‐19 (OR = 1.33 to 3.49) (Del Sole et al, 2020; Patanavanich & Glantz, 2021; Reddy et al, 2021; Rosoff et al, 2021; Wang et al, 2021) and mortality (OR = 1.42 to 2.8) (Dessie & Zewotir, 2021; Mesas et al, 2020). Substance use disorder patients in general have been found to have increased COVID‐19 infection risk (OR = 1.46), with the highest risk in patients with opioid use disorders (OUD) patients (OR = 2.42) (Wang et al, 2021), and also increased hospitalization risk (OUD OR = 1.24; multiple SUDs OR = 1.20) (Board et al, 2022). Several reviews have outlined biological explanations for SUDs as a potential aggravating factor (Althobaiti et al, 2020; Borgonhi et al, 2021; Dubey et al, 2020; Kumar et al, 2022; Schimmel & Manini, 2020; Wang et al, 2021).…”