Alcohol Use and COVID-19 Outcomes

Abstract

Background: There is increasing recognition that health behaviors may contribute to outcomes following COVID-19, but information on the role of alcohol use is limited.

Research question: Are different severity levels of preexisting alcohol use disorder (AUD), alcohol consumption, and their combination associated with 30-day COVID-19 outcomes?

Study design and methods: Using data from a US national cohort (Veterans Health Administration), we determined the risk associated with AUD, based on diagnostic codes including alcohol abuse, alcohol dependence, and alcohol-related disease (ARD) for COVID-19-related outcomes: mild (outpatient management), moderate (hospitalization), critical (hospitalization with indicators of critical illness), or death. We determined the modification of this risk for different levels of self-reported alcohol consumption, using categories defined by an alcohol use screening tool (Alcohol Use Disorders Identification Test-Consumption).

Results: Out of a total of 463,246 veterans who were COVID-19 positive, those with every severity of AUD (abuse, dependence, ARD) had a lower probability of a mild outcome (adjusted risk ratio [aRR] range, 0.75-0.98) and greater probability of hospitalization (aRR range, 1.14-2.50) compared with veterans with no AUD for every level of alcohol consumption. This lower likelihood of a mild outcome and higher likelihood of hospitalization increased with the severity of AUD. Veterans with alcohol dependence had increased probability for critical outcome, but only for high consumption (aRR, 1.28). Veterans with ARD had a higher probability of a critical outcome and death within every level of consumption (aRR range, 1.32-2.01 and aRR range, 1.58-1.91, respectively) with the highest probability seen at high-risk consumption levels.

Interpretation: Overall, AUDs were associated with poorer COVID-19 outcomes. The likelihood of negative outcome generally increased with increasing severity of AUD. The association between the risk of AUD and negative outcome was modified by alcohol consumption, with the poorest outcomes seen with both AUD and high-risk drinking.

Clinical trial registration: ClinicalTrials.gov; No.: NCT04628039; URL: www.

Clinicaltrials: gov.

Keywords: COVID-19; COVID-19(+), COVID-19 positive; SARS-CoV-2; alcohol; patient acuity.