COVID-19 risk and outcomes in patients with substance use disorders: analyses from electronic health records in the United States

Abstract

The global pandemic of COVID-19 is colliding with the epidemic of opioid use disorders (OUD) and other substance use disorders (SUD) in the United States (US). Currently, there is limited data on risks, disparity, and outcomes for COVID-19 in individuals suffering from SUD. This is a retrospective case-control study of electronic health records (EHRs) data of 73,099,850 unique patients, of whom 12,030 had a diagnosis of COVID-19. Patients with a recent diagnosis of SUD (within past year) were at significantly increased risk for COVID-19 (adjusted odds ratio or AOR = 8.699 [8.411-8.997], P < 10^-30), an effect that was strongest for individuals with OUD (AOR = 10.244 [9.107-11.524], P < 10^-30), followed by individuals with tobacco use disorder (TUD) (AOR = 8.222 ([7.925-8.530], P < 10^-30). Compared to patients without SUD, patients with SUD had significantly higher prevalence of chronic kidney, liver, lung diseases, cardiovascular diseases, type 2 diabetes, obesity and cancer. Among patients with recent diagnosis of SUD, African Americans had significantly higher risk of COVID-19 than Caucasians (AOR = 2.173 [2.01-2.349], P < 10^-30), with strongest effect for OUD (AOR = 4.162 [3.13-5.533], P < 10^-25). COVID-19 patients with SUD had significantly worse outcomes (death: 9.6%, hospitalization: 41.0%) than general COVID-19 patients (death: 6.6%, hospitalization: 30.1%) and African Americans with COVID-19 and SUD had worse outcomes (death: 13.0%, hospitalization: 50.7%) than Caucasians (death: 8.6%, hospitalization: 35.2%). These findings identify individuals with SUD, especially individuals with OUD and African Americans, as having increased risk for COVID-19 and its adverse outcomes, highlighting the need to screen and treat individuals with SUD as part of the strategy to control the pandemic while ensuring no disparities in access to healthcare support.

Fig. 1

a Risk associations of recent (diagnosis made in the last year) SUD diagnoses (and its subtypes) with COVID-19; b Risk associations of lifetime (diagnosed in the last year or prior) SUD diagnoses (and its subtypes) with COVID-19. SUD substance use disorder, AUD alcohol use disorder, Cocaine-UD cocaine use disorder, CUD cannabis use disorder, OUD opioid use disorder, TUD tobacco use disorder. Subtypes without sufficient sample sizes for COVID-19 cases are not shown.

Fig. 2. Effects of demographics on COVID-19 susceptibility among patients with recent SUD and its subtypes.

Cocaine-UD and CUD were not examined due to insufficient sample sizes of COVID-19 for stratifications. Senior (age > 65 years). Adult (age 18–65 years).

Fig. 3. Outcomes in patients with COVID-19 and SUD.

a Death rates among patients with COVID-19 and SUD (African American vs. Caucasians); b Hospital admission rates among patients with COVID-19 and SUD (African American vs. Caucasians). The SNOMED-CT concepts “Hospital admission (procedure)” (ID 32485007) was used to obtain hospitalization status from patient EHRs. Explorys regularly imports from the Social Security Death index for the “deceased” status.