Substance use disorders and COVID-19: An analysis of nation-wide Veterans Health Administration electronic health records.
Substance use disorders and COVID-19: An analysis of nation-wide Veterans Health Administration electronic health records.
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DOI：
10.1016/j.drugalcdep.2022.109383
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发表时间：
2022-05-01
影响因子：
4.2
通讯作者：
Wall MM
中科院分区：
文献类型：
--
作者：
Hasin DS;Fink DS;Olfson M;Saxon AJ;Malte C;Keyes KM;Gradus JL;Cerdá M;Maynard CC;Keyhani S;Martins SS;Livne O;Mannes ZL;Sherman SE;Wall MM
物质使用障碍（SUD）增加了COVID-19住院的风险，但关于SUD与COVID-19死亡率的关系的研究并不一致。退伍军人健康管理局（VHA）于2019年接受治疗并于2020年接受COVID-19评估的患者（n = 5，556，315），其中62，303人（1. 1%）COVID-19检测呈阳性（COVID-19+）。结局为2020年1月11日COVID-19+，住院，ICU入院，或在阳性检测后60天内死亡。主要预测因子为任何ICD-10-CM SUD，单独探索了物质特异性SUD（大麻、可卡因、阿片类药物、兴奋剂、镇静剂）。Logistic回归得出未校正和协变量校正的比值比（OR; aOR）。在COVID-19+患者中，19.25%住院，7.71%入住ICU，5.84%死亡。在未调整的模型中，除大麻使用障碍外，任何SUD和所有物质特异性SUD均与COVID-19+相关（OR = 1.06 - 1.85）;调整后的模型产生了类似的结果。任何SUD和所有物质特异性SUD均与住院相关（aOR：1.24 - 1.91）。在未校正但未校正的模型中，任何SUD、可卡因和阿片类药物障碍与ICU入院相关。在未校正的模型中，任何SUD、大麻、可卡因和兴奋剂疾病与死亡率呈负相关（OR = 0.27 - 0.46）。调整后，与死亡率的关联不再显著。在特别分析中，在2019年接受SUD治疗的49.9%的COVID-19 + SUD患者中，调整后的死亡率比值较低，但在未接受此类治疗的患者中则不然。在VHA患者中，SUD与COVID-19住院相关，但与COVID-19死亡率无关。SUD治疗可以提供更密切的护理监测，确保这些患者得到所需的医疗照顾，使他们能够最终在严重疾病中生存下来。
Substance use disorders (SUD) elevate the risk for COVID-19 hospitalization, but studies are inconsistent on the relationship of SUD to COVID-19 mortality. Veterans Health Administration (VHA) patients treated in 2019 and evaluated in 2020 for COVID-19 (n=5,556,315), of whom 62,303 (1.1%) tested positive for COVID-19 (COVID-19+). Outcomes were COVID-19+ by 11/01/20, hospitalization, ICU admission, or death within 60 days of a positive test. Main predictors were any ICD-10-CM SUDs, with substance-specific SUDs (cannabis, cocaine, opioid, stimulant, sedative) explored individually. Logistic regression produced unadjusted and covariate-adjusted odds ratios (OR; aOR). Among COVID-19+ patients, 19.25% were hospitalized, 7.71% admitted to ICU, and 5.84% died. In unadjusted models, any SUD and all substance-specific SUDs except cannabis use disorder were associated with COVID-19+(ORs=1.06–1.85); adjusted models produced similar results. Any SUD and all substance-specific SUDs were associated with hospitalization (aORs: 1.24–1.91). Any SUD, cocaine and opioid disorder were associated with ICU admission in unadjusted but not adjusted models. Any SUD, cannabis, cocaine, and stimulant disorders were inversely associated with mortality in unadjusted models (OR=0.27–0.46). After adjustment, associations with mortality were no longer significant. In ad hoc analyses, adjusted odds of mortality were lower among the 49.9% of COVID-19+ patients with SUD who had SUD treatment in 2019, but not among those without such treatment. In VHA patients, SUDs are associated with COVID-19 hospitalization but not COVID-19 mortality. SUD treatment may provide closer monitoring of care, ensuring that these patients received needed medical attention, enabling them to ultimately survive serious illness.
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期刊：
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