Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, PB 104, Brumunddal, 2381, Norway.
Faculty of Health Studies, VID Specialized University, Oslo, Norway.
Soc Psychiatry Psychiatr Epidemiol. 2024 Aug;59(8):1379-1387. doi: 10.1007/s00127-023-02599-6. Epub 2023 Nov 28.
Most people were affected by the COVID-19 pandemic. Persons with co-occurring substance use disorder (SUD) and mental illness (MI) are already a marginalized group, with above average mortality. Thus, the study aim was to investigate SARS-CoV-2 incidence and mortality among persons with SUD/MI during the first two years of the pandemic.
This historical cohort study merged data from the Norwegian Patient Register, the Norwegian Surveillance System for Communicable Diseases and census data from Statistics Norway. We calculated crude mortality rates for persons with SUD and mild/moderate vs. severe MI and compared them to persons with physical illnesses or healthy controls. The incidence rate ratios for SARS-CoV-2 infection and mortality were estimated using Poisson regression models.
Compared to healthy controls, the SARS-Cov-2-infection rate was marginally lower in persons with SUD and mild/moderate MI (IRR,1.19 [95%CI,1.09-1.30]) as in persons with physical illness (IRR,1.35 [95%CI, 1.23-1.47]), whereas persons with SUD and severe MI showed a lower rate compared to healthy controls. Crude mortality rates for persons with SUD/MI were substantially higher and increased much more during the pandemic than for persons with physical illnesses or healthy controls. The IRR for mortality in persons with SUD and mild/moderate MI was 10.61 (95%CI,7.19-15.67) and 11.44 (95%CI,7.50-17.45) for SUD and severe MI, compared to 5.03 (3.34-7.57]) for persons with physical illnesses only.
The analysis showed excess mortality during COVID-19-pandemic for SUD/MI, but without higher SARS-CoV-2 infection rates in this group. Consequently, excess mortality among persons with SUD/MI was not due to SARS-CoV-2 infection.
大多数人都受到了 COVID-19 大流行的影响。同时患有物质使用障碍（SUD）和精神疾病（MI）的人已经属于边缘化群体，其死亡率高于平均水平。因此，本研究旨在调查大流行的头两年中，同时患有 SUD/MI 的人群中 SARS-CoV-2 的发病率和死亡率。
本历史队列研究合并了来自挪威患者登记处、挪威传染病监测系统和挪威统计局人口普查数据。我们计算了患有 SUD 和轻度/中度 MI 与患有躯体疾病或健康对照者的粗死亡率，并将其与健康对照者进行比较。使用泊松回归模型估计了 SARS-CoV-2 感染和死亡率的发病率比值。
与健康对照者相比，患有 SUD 和轻度/中度 MI 的人群中 SARS-CoV-2 感染率略低（IRR，1.19[95%CI，1.09-1.30]），而患有躯体疾病的人群感染率更高（IRR，1.35[95%CI，1.23-1.47]），而患有 SUD 和严重 MI 的人群感染率则较低。患有 SUD/MI 的人群的粗死亡率明显更高，且在大流行期间的增幅远高于患有躯体疾病或健康对照者。患有 SUD 和轻度/中度 MI 的人群的死亡率的 IRR 为 10.61（95%CI，7.19-15.67）和 11.44（95%CI，7.50-17.45），而仅患有躯体疾病的人群的死亡率的 IRR 为 5.03（3.34-7.57]）。
本分析显示，SUD/MI 在 COVID-19 大流行期间存在超额死亡率，但该人群的 SARS-CoV-2 感染率并没有更高。因此，SUD/MI 人群的超额死亡率不是由 SARS-CoV-2 感染引起的。
