Metz Verena E, Palzes Vanessa A, Chi Felicia W, Campbell Cynthia I, Sterling Stacy A
Center for Addiction and Mental Health Research, Kaiser Permanente Division of Research, Oakland, CA, United States.
Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States.
Front Psychiatry. 2022 Jul 12;13:883306. doi: 10.3389/fpsyt.2022.883306. eCollection 2022.
Individuals globally were affected by the COVID-19 pandemic in myriad of ways, including social isolation and economic hardship, resulting in negative impacts on mental health and substance use. Young adults have been subjected to extraordinary challenges such as job loss, virtual school, or childcare issues, but have received limited attention from research so far.
Using electronic health record data from a large integrated healthcare system in Northern California, this longitudinal observational study examined changes in the prevalence of unhealthy alcohol use (identified systematic alcohol screening in adult primary care) from pre- (3/1/2019-12/31/2019) to post-COVID onset (3/1/2020-12/31/2020) among young adults (18-34 years). Among the 663,111 and 627,095 young adults who utilized primary care in the pre- and post-COVID onset periods, 342,889 (51.9%) and 186,711 (29.8%) received alcohol screening, respectively. We fit generalized estimating equation Poisson models to estimate the change in prevalence of unhealthy alcohol use from pre- to post-COVID onset among those who were screened, while using inverse probability weighting to account for potential selection bias of receiving alcohol screening. Heterogeneity in the change of prevalence by patient characteristics was also examined.
Overall, the unadjusted prevalence of unhealthy alcohol use slightly decreased from 9.2% pre-COVID to 9.0% post-COVID onset. After adjusting for patient covariates, the prevalence of unhealthy alcohol use decreased by about 2% [adjusted prevalence ratio (aPR) = 0.98, 95% CI = 0.96, 1.00]. The prevalence of unhealthy alcohol use increased among women by 8% (aPR = 1.08, 95% CI = 1.06, 1.11), patients 18-20 years by 7% (aPR = 1.07, 95% CI = 1.00, 1.15), and Latino/Hispanic patients by 7% (aPR = 1.07, 95% CI = 1.03, 1.11). While the prevalence of unhealthy alcohol use decreased among men by 12% (aPR = 0.88, 95% CI = 0.86, 0.90), patients 21-34 years by 2% (aPR = 0.98, 95% CI = 0.96, 0.99), White patients by 3% (95% CI = 0.95, 1.00), and patients living in neighborhoods with the lowest deprivation indices by 9% (aPR = 0.91, 95% CI = 0.88, 0.94), their unadjusted prevalence remained higher than their counterparts post-COVID onset. There was no variation in the change of prevalence by comorbid mental health conditions or drug use disorders.
While changes in unhealthy alcohol use prevalence among young adults were small, findings raise concerns over increased drinking among women, those younger than the U.S. legal drinking age, and Latino/Hispanic patients.
全球范围内的个人都受到了新冠疫情的多种影响，包括社会隔离和经济困难，对心理健康和物质使用产生了负面影响。年轻人面临着诸如失业、虚拟学校或儿童保育问题等特殊挑战，但迄今为止在研究中受到的关注有限。
利用北加利福尼亚一个大型综合医疗系统的电子健康记录数据，这项纵向观察性研究考察了年轻人（18至34岁）在新冠疫情前（2019年3月1日至2019年12月31日）至新冠疫情爆发后（2020年3月1日至2020年12月31日）不健康饮酒患病率（通过成人初级保健中的系统酒精筛查确定）的变化。在新冠疫情前和后使用初级保健的663,111名和627,095名年轻人中，分别有342,889名（51.9%）和186,711名（29.8%）接受了酒精筛查。我们拟合广义估计方程泊松模型，以估计在接受筛查的人群中，从新冠疫情前到疫情爆发后不健康饮酒患病率的变化，同时使用逆概率加权来考虑接受酒精筛查的潜在选择偏倚。还考察了患者特征导致的患病率变化的异质性。
总体而言，不健康饮酒的未调整患病率从新冠疫情前的9.2%略有下降至疫情爆发后的9.0%。在调整患者协变量后，不健康饮酒的患病率下降了约2%[调整患病率比（aPR）=0.98，95%置信区间=0.96，1.00]。女性中不健康饮酒的患病率上升了8%（aPR = 1.08，95%置信区间=1.06，1.11），18至20岁的患者上升了7%（aPR = 1.07，95%置信区间=1.00，1.15），拉丁裔/西班牙裔患者上升了7%（aPR = 1.07，95%置信区间=1.03，1.11）。而男性中不健康饮酒的患病率下降了12%（aPR = 0.88，95%置信区间=0.86，0.90），21至34岁的患者下降了2%（aPR = 0.98，95%置信区间=0.96，0.99），白人患者下降了3%（95%置信区间=0.95，1.00）居住在贫困指数最低社区的患者下降了9%（aPR = 0.91，95%置信区间=0.88，0.94），他们未调整的患病率仍高于新冠疫情爆发后的对应人群。共病心理健康状况或药物使用障碍导致的患病率变化没有差异。
虽然年轻人中不健康饮酒患病率的变化很小，但研究结果引发了对女性、低于美国法定饮酒年龄的人群以及拉丁裔/西班牙裔患者饮酒增加的担忧。
