Introduction

The SARS-CoV-2 (COVID-19) pandemic may disproportionately affect vulnerable populations, including people with substance use disorders (SUDs).^1,2 Evidence suggests that individuals with SUDs are at increased risk of COVID-19,³ but little is known about relationships between SUDs, overdose and COVID-19 severity and mortality.⁴ To address this gap, we conducted a retrospective study of patients tested for COVID-19 at a hospital system in New York City (NYC), an early COVID-19 hotspot and jurisdiction with high rates of opioid and other drug overdose (OD).⁵

Methods

We conducted a retrospective review of data from NYU Langone Health (NYULH), an academic medical center comprising four acute care hospitals across greater NYC.

Table 1

Characteristics of patients tested for COVID-19 by PCR, 1 January to 26 October 2020

Table 2

Odds of adverse COVID-19 outcomes by SUD and overdose history

We used NYULH’s COVID-19 Deidentified Clinical Database (CDCD), including patients tested for COVID-19 between 1 January and 26 October 2020 (N = 188,653). COVID-19 cases were defined as patients with positive results on reverse transcriptase polymerase chain reaction (PCR) assays of nasopharyngeal swab specimens. Before 16 March 2020, samples were analyzed by the NYC Public Health Laboratory or New York State Wadsworth Laboratory. Beginning 16 March 2020, the NYULH clinical laboratory analyzed samples. Use of the CDCD is exempt under NYULH’s Institutional Review Board.

We assessed four outcomes: positive COVID-19 tests, hospitalizations, intensive care unit (ICU) admissions and death. We defined hospitalizations and ICU admissions as admissions for patients with positive tests whose COVID-19 diagnoses were dated concurrently or prior to admission. SUDs and overdose were assessed using ICD-10 codes F10 (alcohol use disorder; AUD), F11 (opioid use disorder; OUD), F12 (cannabis use disorder; CAUD), F14 (cocaine use disorder; COUD), T40 (OD) and F10–F16 and F18–F19 (any SUD). Diabetes, heart failure, chronic kidney disease and asthma, chronic obstructive pulmonary disease (COPD) and emphysema were assessed, guided by research on COVID-19 outcomes at NYULH.⁶ Patient sex, age group, race and living status were obtained from the CDCD.

We calculated descriptive statistics and bivariable analyses to compare the prevalence of COVID-19 by baseline characteristics. We used logistic regression to estimate unadjusted and sex-, age-, race- and comorbidity-adjusted odds ratios (AORs) for associations between SUD indicators and outcomes. A Bonferroni-corrected P < 0.0125 was used for statistical significance (corrected for four outcomes). Analyses were conducted using R version 3.6.2.

Results

Of patients tested for COVID-19 (n = 188 653), 57.0% were female; 22.5% were 65 years or older; 41.9% were non-Hispanic white, 28.4% Hispanic/Latino and 10.7% non-Hispanic Black. Asthma/COPD/emphysema was the most prevalent comorbidity (n = 23 132, 12.3%), followed by diabetes (n = 21 101, 11.2%), chronic kidney disease (n = 10 313, 5.5%) and heart failure (7734, 4.1%). In total, 5107 patients had any SUD (2.7%), with AUD most prevalent (n = 2,582; 1.4%), followed by CAUD (n = 1,148, 0.6%), OUD (n = 865, 0.5%) and COUD (n = 541, 0.3%). Overdose was observed in 664 patients (0.4%). COVID-19 incidence was 6.3% positive (Table 1).

Overdose was associated with COVID-19 [AOR 1.49 (95% confidence interval; CI: 1.16–1.91). Each SUD indicator except COUD was associated with hospitalization; AORs ranged from 4.35 (3.30–5.73) for SUD to 6.68 (4.33–10.33) for AUD. SUD, AUD and OUD were associated with over 2.5 times the odds of ICU admission, and OD with five times the odds [5.00 (3.02–8.30)]. Overdose was associated with mortality [3.03 (1.70–5.43)] (Table 2).

Discussion

This study corroborates prior research and demonstrates that patients with SUDs face disproportionate risk of critical COVID-19 illness.³ Although COVID-19 diagnoses were dated concurrently or prior to admission, we cannot assure whether outcomes were due to COVID-19 or unrelated. Additionally, we adjusted for few comorbidities; due to missing data, body mass index, an important predictor,⁶ was not assessed. Despite these limitations, this study highlights the need for research identifying risk mechanisms of severe COVID-19 among patients with SUD, such as presentation timing or provider stigma.

Funding

OES and MRK received support from the New York University Center for Drug Use and HIV Research (P30 DA011041). MRK received support from the New York University-City University of New York (NYU-CUNY) Prevention Research Center (U48 DP005008). OES received support from the New York State Department of Health Empire Clinical Research Investigator Program (ECRIP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding sponsors, who had no role in study design; data collection, analyses, or interpretation; manuscript preparation; or decision to publish the results.

Conflicts of interest

The authors declare no conflicts of interest.

Bennett Allen, PhD Student

Omar El Shahawy, Assistant Professor

Erin S. Rogers, Assistant Professor

Sarah Hochman, Assistant Professor

Maria R. Khan, Associate Professor

Noa Krawczyk, Assistant Professor

Summary

A retrospective study analyzed data from 188,653 patients tested for COVID-19 at NYU Langone Health between January 1 and October 26, 2020, to investigate the relationship between substance use disorders (SUDs), overdose, and COVID-19 severity and mortality. The study utilized the NYU Langone Health COVID-19 Deidentified Clinical Database and assessed four outcomes: positive COVID-19 tests, hospitalizations, ICU admissions, and death. Various SUDs and overdose were assessed using ICD-10 codes. Logistic regression was used to analyze the association between SUD indicators and outcomes.

Methods

The study population encompassed patients tested for COVID-19 at NYU Langone Health, employing data from a de-identified clinical database. COVID-19 cases were defined based on positive PCR test results. The study assessed multiple outcomes, including COVID-19 positivity, hospitalizations, ICU admissions, and mortality. SUDs and overdose were identified using specific ICD-10 codes. Additional comorbidities, including diabetes, heart failure, chronic kidney disease, and respiratory conditions, were also considered. Statistical analyses, including descriptive statistics and logistic regression modeling, were used to evaluate the relationships between SUDs, overdose, and COVID-19 outcomes.

Results

The study included a large sample size with a diverse demographic representation. A significant percentage of patients had at least one comorbidity. The prevalence of various SUDs and overdose was documented. The analysis revealed a statistically significant association between overdose and several adverse COVID-19 outcomes, including hospitalization, ICU admission, and mortality. Similarly, various SUDs were associated with increased odds of hospitalization and ICU admission.

Discussion

The findings demonstrate a substantial correlation between SUDs, overdose, and adverse COVID-19 outcomes. While the study acknowledges limitations, such as potential confounding factors and missing data, the results highlight the elevated risk faced by individuals with SUDs during the COVID-19 pandemic. Further research is needed to elucidate underlying mechanisms and inform targeted interventions for this vulnerable population.

Summary

This retrospective study investigated the relationship between substance use disorders (SUDs), overdose, and COVID-19 severity and mortality among a large cohort of patients tested for COVID-19 at a New York City hospital system. The study utilized a clinical database encompassing nearly 190,000 patients tested between January 1 and October 26, 2020.

Methods

Researchers analyzed data from the NYU Langone Health COVID-19 Deidentified Clinical Database. The study defined COVID-19 cases based on positive PCR tests and assessed four outcomes: positive COVID-19 tests, hospitalizations, ICU admissions, and death. SUDs and overdose were identified using ICD-10 codes. Several comorbidities were also considered. Statistical analyses included descriptive statistics, bivariable analyses, and logistic regression to determine associations between SUD indicators and COVID-19 outcomes.

Results

Among the patients tested, 2.7% had any SUD, with alcohol use disorder being the most prevalent. 0.4% had a history of overdose. Overdose was significantly associated with a higher likelihood of a positive COVID-19 test, hospitalization, ICU admission, and death. Most SUD indicators, excluding cocaine use disorder, were linked to increased odds of hospitalization. SUD, alcohol use disorder, and opioid use disorder were associated with over 2.5 times the odds of ICU admission.

Discussion

The findings support the disproportionate risk of severe COVID-19 illness among individuals with SUDs. Limitations include the inability to definitively determine causality between COVID-19 and observed outcomes and the limited number of comorbidities adjusted for in the analysis. Further research is warranted to elucidate the mechanisms underlying this heightened risk.

Summary

A study at NYU Langone Health examined the link between substance use disorders (SUDs), overdoses, and COVID-19 outcomes in a large New York City population. Researchers reviewed data from over 188,000 patients tested for COVID-19 between January 1 and October 26, 2020. They analyzed the relationship between SUDs, including alcohol, opioid, cannabis, and cocaine use disorders, and various COVID-19 outcomes like positive tests, hospitalizations, ICU admissions, and death. The study aimed to understand if people with SUDs experienced worse outcomes.

Methods

The study used data from NYU Langone Health's COVID-19 database. Researchers looked at patient characteristics like age, sex, race, and pre-existing health conditions (comorbidities). They focused on four main outcomes of COVID-19: positive test results, hospitalization, ICU admission, and death. Statistical methods were employed to determine the strength of the relationship between SUDs, overdoses, and these outcomes, taking into account other factors that could influence the results.

Results

The study found that having a history of overdose was associated with a higher chance of getting COVID-19, needing hospitalization, and even death. Most types of SUDs were linked to an increased likelihood of hospitalization and ICU admission. Specifically, alcohol use disorder was strongly associated with worse COVID-19 outcomes.

Discussion

The findings confirm earlier research showing that people with SUDs are at higher risk for severe COVID-19. The study acknowledges limitations, such as the inability to definitively prove that COVID-19, rather than other factors, caused the worse outcomes. Despite these limitations, the results emphasize the need for further research to understand why people with SUDs experience more severe COVID-19 and how to better support them.

Summary

This study looked at how COVID-19 affected people with substance use disorders (SUDs) in New York City. Researchers reviewed medical records from a large hospital system. They wanted to see if having a SUD made COVID-19 worse.

Methods

The researchers used data from many patients tested for COVID-19. They looked at things like whether patients had a SUD, and if they had a drug overdose. They also checked if patients had other health problems. The researchers then compared how COVID-19 affected people with and without SUDs. They wanted to see if having a SUD increased the risk of serious illness from COVID-19.

Results

The study found that people with SUDs were much more likely to be hospitalized, need intensive care, and even die from COVID-19 compared to those without SUDs. People who had a drug overdose had the highest risk of serious COVID-19 outcomes.

Discussion

This study shows that people with SUDs have a higher chance of getting very sick from COVID-19. More research is needed to understand why.