The Impact of Substance Use Disorder on COVID-19 Outcomes

Abstract

The goal of this study was to examine the impact of substance use disorder on the risk of hospitalization, complications, and mortality among adult patients diagnosed as having COVID-19. Methods: The authors conducted a propensity score (PS)matched double-cohort study (N55,562 in each cohort) with data from the TriNetX Research Network database to identify 54,529 adult patients ($18 years) diagnosed as having COVID-19 between February 20 and June 30, 2020. Results: Primary analysis (PS matched on demographic characteristics and presence of diabetes and obesity) showed that substance use disorder was associated with an increased risk of hospitalization (odds ratio [OR]=1.84, 95% confidence interval [CI]=1.69-2.01), ventilator use (OR=1.45, 95% CI=1.22-1.72), and mortality (OR=1.30, 95% CI=1.08-1.56). Conclusions: The findings suggest that COVID-19 patients with substance use disorders are at increased risk for adverse outcomes. The attenuation of ORs in the model that matched for chronic respiratory and cardiovascular diseases associated with substance abuse suggests that the observed risks may be partially mediated by these conditions.

The effects of substance use on severe acute respiratory syndrome coronavirus infection risks and outcomes

“…All the twelve included articles concluded, at least theoretically, that having a preexisting diagnosis of SUD increased the risk of infection with SARS-CoV2 [ 2 ▪▪ , 3 ▪▪ , 7 , 8 , 9 ▪ , 10 , 11 ▪ – 13 ▪ , 14 – 16 ]. Among those diagnosed with COVID-19, a significant proportion had diagnoses of SUDs [ 2 ▪▪ , 3 ▪▪ , 7 , 8 , 9 ▪ , 10 , 11 ▪ – 13 ▪ , 14 – 16 ]. This increased risk can be further stratified into socioeconomic disparities and medical comorbidities.…”

“…Generally, those with SUDs were also found to be more likely to have a compromised immune system [ 7 , 9 ▪ , 12 ▪ , 13 ▪ ]. A large proportion of individuals with SUDs have underlying immunosuppressive conditions such as HIV or liver cirrhosis secondary to hepatitis C infection, which can make them more susceptible to severe illness from viral pathogens [ 7 ].…”

“…Eleven of the twelve articles also concluded that a history of substance use increases the risk of most adverse outcomes from COVID-19 infection, including hospitalization due to severe disease and even death [ 2 ▪▪ , 3 ▪▪ , 7 , 8 , 9 ▪ , 10 , 11 ▪ – 13 ▪ , 14 – 16 ]Table 1 . It was estimated that the increase in the risk of hospitalization due to complications from COVID-19 ranged as high as 50% [ 3 ▪▪ , 9 ▪ ]. This risk persisted even when adjusting for other confounding variables such as obesity and demographic characteristics and even when adjusting for preexisting conditions.…”

“…The increased risk of hospitalization (30.9% vs 22.6%, OR = 1.53, 95% CI = 1.40–1.65) persisted even when individuals were matched based on several preexisting conditions such as hypertension, chronic obstructive pulmonary disease, heart disease, and cerebrovascular disease. In this population, however, there was not an observable increase in risk of mortality (4.7% vs 4.7%, OR = 1.00, 95% CI = 0.84–1.20) [ 9 ▪ ]. Individuals with SUDs were generally observed to have higher rates of several underlying health conditions, such as diabetes, cardiovascular diseases, cancers, chronic kidney disease, asthma and other respiratory diseases, hypertension, and obesity [ 2 ▪▪ , 3 ▪▪ , 11 ▪ , 12 ▪ , 8 ].…”

“…The remaining six articles were an evidence-informed policy brief, a matched cohort study, an observational study, an online survey, a retrospective case-control study, and a retrospective review. Only a limited number of articles directly assessed patient data or outcomes [ 3 ▪▪ , 7 , 8 , 9 ▪ , 10 ].…”