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COVID-19 risk and outcomes in patients with substance use disorders: analyses from electronic health records in the United States - increased risk of COVID & had worse outcomes, heroin the worst
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Sept 2020 Molecular Psychiatry - Quan Qiu Wang1 • David C. Kaelber2 • Rong Xu 1 • Nora D. Volkow 3
Download the PDF here
• This is a retrospective case-control study of electronic health records (EHRs) data of 73,099,850 unique patients, of whom 12,030 had a diagnosis of COVID-19.
• 10.3% of the study population had a diagnosis of SUD, which is similar to the reported prevalence of 10.8% among people aged 18 or older in the US according to the 2018 National Survey on Drug Use and Health (NSDUH) [5].
• The analyses showed that a recent diagnosis of SUD significantly increased the risk of COVID-19 that was highest for recent diagnosis of OUD followed by TUD, AUD and Cocaine-UD, and lowest for CUD.
• Patients with both SUD and COVID-19 also had significantly worse outcomes (death, hospitalization) than general COVID-19 patients. Patients with a recent diagnosis of SUD (within past year) were at significantly increased risk for COVID-19 (adjusted odds ratio or AOR = 8.699 [8.411-8.997], P < 10-30), an effect that was strongest for individuals with OUD (AOR = 10.244 [9.107-11.524], P < 10-30), followed by individuals with tobacco use disorder (TUD) (AOR = 8.222 ([7.925-8.530], P < 10-30).
• Compared to patients without SUD, patients with recent SUD had significantly higher prevalence of chronic kidney, liver, lung diseases, cardiovascular diseases, type 2 diabetes, obesity and cancer. However, the prevalence of known risk factor for COVID-19 among patients with OUD was not higher than patients with other types of SUD.
• These results suggest that while comorbidities associated with SUD likely contributed to the increased risk of COVID-19 and to worse outcomes among SUD patients, specific pharmacological effects of drugs of abuse (e.g., opioid induced respiratory depression) as well as behavioral and socioeconomic factors could facilitate COVID-19 infection and increase risk for adverse outcomes.
• Among patients with recent diagnosis of SUD, African Americans had significantly higher risk of COVID-19 than Caucasians, an effect that was strongest for African Americans with OUD and they also had worse outcomes (death and hospitalizations).
The baseline characteristics of the study population (as of June 15, 2020) are presented in Table 1. Among 73,099,850 patients, 7,510,380 patients had lifetime SUD (diagnosed within the last or prior years) (10.27% of study population), including 1,264,990 with AUD (1.73% of study population), 222,680 with Cocaine-UD (0.30%), 490,420 with CUD (0.67%), 6,414,580 with TUD (8.77%), and 471,520 with OUD (0.65%). Among 73,099,850 patients, 722,370 had recent SUD (diagnosed within the last year) (0.99% of total population), including 83,100 with AUD (0.11%), 14,800 with Cocaine-UD (0.02%), 27,650 with CUD (0.04%), 611,750 with TUD (0.84%), and 43,160 with OUD (0.06%).
Abstract
The global pandemic of COVID-19 is colliding with the epidemic of opioid use disorders (OUD) and other substance use disorders (SUD) in the United States (US). Currently, there is limited data on risks, disparity, and outcomes for COVID-19 in individuals suffering from SUD. This is a retrospective case-control study of electronic health records (EHRs) data of 73,099,850 unique patients, of whom 12,030 had a diagnosis of COVID-19.
Patients with a recent diagnosis of SUD (within past year) were at significantly increased risk for COVID-19 (adjusted odds ratio or AOR = 8.699 [8.411-8.997], P < 10-30), an effect that was strongest for individuals with OUD (AOR = 10.244 [9.107-11.524], P < 10-30), followed by individuals with tobacco use disorder (TUD) (AOR = 8.222 ([7.925-8.530], P < 10-30).
Compared to patients without SUD, patients with SUD had significantly higher prevalence of chronic kidney, liver, lung diseases, cardiovascular diseases, type 2 diabetes, obesity and cancer.
Among patients with recent diagnosis of SUD, African Americans had significantly higher risk of COVID-19 than Caucasians (AOR = 2.173 [2.01-2.349], P < 10-30), with strongest effect for OUD (AOR = 4.162 [3.13-5.533], P < 10-25).
COVID-19 patients with SUD had significantly worse outcomes (death: 9.6%, hospitalization: 41.0%) than general COVID-19 patients (death: 6.6%, hospitalization: 30.1%) and African Americans with COVID-19 and SUD had worse outcomes (death: 13.0%, hospitalization: 50.7%) than Caucasians (death: 8.6%, hospitalization: 35.2%).
These findings identify individuals with SUD, especially individuals with OUD and African Americans, as having increased risk for COVID-19 and its adverse outcomes, highlighting the need to screen and treat individuals with SUD as part of the strategy to control the pandemic while ensuring no disparities in access to healthcare support.
From ID week 2020.
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