COVID-19 complications among patients with opioid use disorder: a retrospective cohort study across five major NYC hospital systems
COVID-19 complications among patients with opioid use disorder: a retrospective cohort study across five major NYC hospital systems
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DOI：
10.1111/add.16105
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发表时间：
2023-01-08
期刊：
影响因子：
6
通讯作者：
Martinez，Diana
中科院分区：
文献类型：
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作者：
Krawczyk，Noa;Rivera，Bianca D.;Martinez，Diana
背景和目的阿片类药物使用障碍(OUD)患者患新冠肺炎的比例较高。为指导OUD患者的临床治疗，需要研究确定这一人群中与新冠肺炎进展和死亡相关的特征。设计对来自五个大型私营医疗系统的合并电子健康记录的设计回顾队列研究。背景：美国纽约纽约市，2011-21年。参与者在2020年3月至2021年2月期间遇到新冠肺炎并被诊断为OUD或阿片类药物过量的成年人。危险因素包括年龄、性别、种族/民族以及已知与新冠肺炎严重程度相关的常见内科、药物使用和精神共病。结果包括入院和随后的新冠肺炎插管，急性肾功能衰竭，严重败血症和死亡。在110 917新冠肺炎+ 的成年人中，1.17%的人曾被诊断为OUD/阿片类药物过量。OUD患者发生新冠肺炎住院[调整风险比(ARR) = 1.40，95%可信区间(CI) = 1.33，1.47]，插管[调整优势比(AOR) = 2.05，95%CI = 1.74，2.42]，肾功能衰竭(ARR = 1.51，95%CI = 1.34，1.70)，脓毒症(ARR = 2.30，95%CI = 1.88，死亡(ARR = 2.10，95%CI = 1.84，2.40)。在住院的OUD患者中，新冠肺炎预后较差的风险包括男性、年龄较大、白人、黑人或西班牙裔以外的种族/民族，以及患有慢性肾脏疾病、糖尿病、肥胖或癌症。保护性因素包括哮喘、丙型肝炎和慢性疼痛。结论阿片类药物使用障碍患者似乎有很大的风险与新冠肺炎相关的发病率和死亡率，特别是合并疾病和治疗可以缓解这种风险。
Background and AimsIndividuals with opioid use disorder (OUD) suffer disproportionately from COVID‐19. To inform clinical management of OUD patients, research is needed to identify characteristics associated with COVID‐19 progression and death among this population. We aimed to investigate the role of OUD and specific comorbidities on COVID‐19 progression among hospitalized OUD patients.DesignRetrospective cohort study of merged electronic health records (EHR) from five large private health systems.SettingNew York City, New York, USA, 2011–21.ParticipantsAdults with a COVID‐19 encounter and OUD or opioid overdose diagnosis between March 2020 and February 2021.MeasurementsPrimary exposure included diagnosis of OUD/opioid overdose. Risk factors included age, sex, race/ethnicity and common medical, substance use and psychiatric comorbidities known to be associated with COVID‐19 severity. Outcomes included COVID‐19 hospitalization and subsequent intubation, acute kidney failure, severe sepsis and death.FindingsOf 110 917 COVID‐19+ adults, 1.17% were ever diagnosed with OUD/opioid overdose. OUD patients had higher risk of COVID‐19 hospitalization [adjusted risk ratio (aRR) = 1.40, 95% confidence interval (CI) = 1.33, 1.47], intubation [adjusted odds ratio (aOR) = 2.05, 95% CI = 1.74, 2.42], kidney failure (aRR = 1.51, 95% CI = 1.34, 1.70), sepsis (aRR = 2.30, 95% CI = 1.88, 2.81) and death (aRR = 2.10, 95% CI = 1.84, 2.40). Among hospitalized OUD patients, risks for worse COVID‐19 outcomes included being male; older; of a race/ethnicity other than white, black or Hispanic; and having comorbid chronic kidney disease, diabetes, obesity or cancer. Protective factors included having asthma, hepatitis‐C and chronic pain.ConclusionsOpioid use disorder patients appear to have a substantial risk for COVID‐19‐associated morbidity and mortality, with particular comorbidities and treatments moderating this risk.