Substance, Alcohol Abuse Associated with Severe COVID-19 Outcomes

People with a history of a substance or alcohol use disorder are more likely to be hospitalized with a coronavirus disease 2019 (COVID-19) infection, compared to the general public, according to a new report. Once admitted to the hospital, they also face higher mortality rates, the study found.

The findings were published in the journal Psychiatry Research and are based on population data from the Bologna region of northern Italy.

Raimondo Pavarin

Previous research has already shown that patients with substance use disorder (SUD) and alcohol use disorder (AUD) are particularly vulnerable to COVID-19, noted corresponding author Raimondo Maria Pavarin, Ph.D., of the University of Bologna, and colleagues.

They said a number of factors, such as behaviors associated with substance use, and the context in which patients use alcohol and drugs, can put patients at an additional risk.

“Risks are increased by the high level of physical and psychiatric comorbidity, use of drugs that impair the cardiovascular and respiratory systems, the social marginalization and the stigmatization that people who use drugs often experience,” the investigators wrote.

They added that increased rates of poverty and other vulnerabilities meant patients with AUD or SUD were more likely to be affected by the COVID-19 lockdown-related disruptions of services.

Having examined the existing data, Pavarin and colleagues wanted to see whether people with AUD/SUD might be more likely to have severe cases of COVID-19. To find out, they used the metrics of hospitalization and in-hospital mortality, and compared public health service data from the general population to data for patients who had been diagnosed with AUD or SUD between 2009 and 2019. All of the subjects in the study were between the ages of 18 and 79.

The database included 5,135 patients diagnosed with AUD and 6,081 patients diagnosed with SUD. Both groups were made up mostly of males (roughly three-quarters in each cohort). The AUD group had an average age of 52.6 years, while the SUD group’s average age was 44.2 years. Among the latter group, heroin (50%), cocaine (23%), and cannabis (10%) were the most commonly used drugs.

In terms of hospitalizations, the general population in Bologna had a COVID-19 hospitalization rate of 5.06 hospitalizations per 1,000 residents. Though the sample size of patients with SUD who were hospitalized with COVID-19 was small (just 35 patients), it translated to a fairly similar hospitalization rate of 5.76 hospitalizations per 1,000 people.

However, among patients with AUD, the hospitalization rate was 10.13 COVID-19 hospitalizations per 1,000 people.

Among general population patients hospitalized with COVID-19, the mortality rate was 94.74 per 1,000 people, the investigators said. However, it was much higher in hospitalized patients with SUD and AUD, at 142.86 deaths and 173.08 deaths per 1,000 people, respectively.

Pavarin and colleagues said men with AUD or SUD were more likely than females to be hospitalized, and in both diagnostic groups, age was a risk factor for hospitalization.

“Our results supported the hypothesis that people with SUDs and/or AUDs have a greater probability of being hospitalized for COVID-19 infection and to die during hospitalization compared to the general population, suggesting that they suffer from worse physical symptoms/conditions than the general population,” the investigators said.

Pavarin and colleagues said the data underscore the importance of early intervention and close monitoring of patients with AUD/SUD who contract COVID-19, but they added that the data also highlight the need to address disparities more generally that affect this population.

“Policies aiming at avoiding social marginalization and disparities in access to health care services may reduce the risk of poor prognosis of COVID-19 infection in patients with AUDs/SUDs,” they concluded.