Center for Artificial Intelligence in Drug Discovery, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
Departments of Internal Medicine and Pediatrics and the Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH, USA.
Mol Psychiatry. 2021 Jan;26(1):30-39. doi: 10.1038/s41380-020-00880-7. Epub 2020 Sep 14.
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), an effect that was strongest for individuals with OUD (AOR = 10.244 [9.107-11.524], P < 10), followed by individuals with tobacco use disorder (TUD) (AOR = 8.222 ([7.925-8.530], P < 10). 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), with strongest effect for OUD (AOR = 4.162 [3.13-5.533], P < 10). 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.
全球 COVID-19 大流行与美国阿片类药物使用障碍（OUD）和其他物质使用障碍（SUD）的流行相碰撞。目前，关于 SUD 个体 COVID-19 的风险、差异和结局的数据有限。这是一项对 73099850 个独特患者电子健康记录（EHR）数据的回顾性病例对照研究，其中 12030 例被诊断为 COVID-19。最近诊断为 SUD（过去 1 年内）的患者感染 COVID-19 的风险显著增加（校正比值比或 AOR=8.699[8.411-8.997]，P<0.001），阿片类药物使用障碍（OUD）患者的风险最高（AOR=10.244[9.107-11.524]，P<0.001），其次是烟草使用障碍（TUD）患者（AOR=8.222[7.925-8.530]，P<0.001）。与无 SUD 患者相比，SUD 患者患慢性肾脏、肝脏、肺部疾病、心血管疾病、2 型糖尿病、肥胖症和癌症的比例显著更高。在最近诊断为 SUD 的患者中，非裔美国人感染 COVID-19 的风险显著高于白人（AOR=2.173[2.01-2.349]，P<0.001），OUD 患者的效应最强（AOR=4.162[3.13-5.533]，P<0.001）。SUD 合并 COVID-19 的患者的结局（死亡：9.6%，住院：41.0%）显著差于一般 COVID-19 患者（死亡：6.6%，住院：30.1%），而非裔美国人合并 COVID-19 和 SUD 的患者的结局（死亡：13.0%，住院：50.7%）显著差于白人（死亡：8.6%，住院：35.2%）。这些发现表明 SUD 患者，特别是 OUD 患者和非裔美国人，感染 COVID-19 的风险增加，且其结局不良，这突显了筛查和治疗 SUD 患者作为控制大流行策略的一部分的必要性，同时确保在获得医疗支持方面没有差异。
