COVID-19: substance use disorder is linked to worse outcomes

  • Baillargeon J & al.
  • Psychiatr Serv
  • 03/11/2020

  • Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Patients with substance use disorder (SUD) who are diagnosed with COVID-19 have significantly worse outcomes than those without SUD, including increased risk for hospitalization and ventilator use and death.
  • Drug-related cardiovascular and respiratory disease may mediate the mortality effect.

Why this matters

  • The presence of SUD might call for increased vigilance and attention to respiratory and cardiovascular history.

Study design

  • Propensity score matching cohort study.
  • 54,529 adults from the TriNetX Research Network database who were diagnosed with COVID-19.
  • Cohorts:
    • By demographic characteristics, obesity, and diabetes (cohort 1; n=5562)
    • By the same characteristics in cohort 1 plus hypertension, COPD, ischemic heart disease, and cerebrovascular disease (cohort 2; n=5450).
  • Funding: Agency for Healthcare Research and Quality.

Key results

  • 10.2% had a SUD.
  • In cohort 1, SUD vs no SUD was associated with a significantly increased risk (95% CIs) for:
    • Hospitalization:
      • 32.5% vs 20.7%.
      • aOR: 1.84 (1.69-2.01),
    • Ventilator use:
      • 6.0% vs 4.2%. 
      • OR: 1.45 (1.22-1.72).
    • Mortality:
      • 4.9% vs 3.8%.
      • OR: 1.30 (1.08-1.56).
  • In cohort 2, SUD remained associated with significantly increased risks for: 
    • Hospitalization:
      • 30.9% vs 22.6%.
      • OR, 1.53 (1.40-1.65). 
    • Ventilator use:
      • 5.4% vs 4.3%.
      • OR, 1.28 (1.07-1.52).
    • However, risk for mortality was not increased.

Limitations

  • No data on socioeconomic status, health care use for preexisting conditions, or region of residence.