COVID-19 risk and outcomes in patients with substance use disorders: analyses from electronic health records in the United States
Open accessAbstract
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 < 10-30), an effect that was strongest for individuals with OUD (AOR = 10.244 [9.107-11.524], P < 10-30), followed by individuals with tobacco use disorder (TUD) (AOR = 8.222 ([7.925-8.530], P < 10-30). 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 < 10-30), with strongest effect for OUD (AOR = 4.162 [3.13-5.533], P < 10-25). 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.
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Hospitalized COVID-19 patients with psychiatric disorders had a higher likelihood of intubation or death.
“We found that individuals with psychiatric disorders and hospitalized for COVID-19 would be at higher risk of intubation or death, in line with findings of recent studies [33,34].”
From Association between antidepressant use and reduced risk of intubation or death in hospitalized patients with COVID-19: results from an observational study (2021) · cites this paper as [33]
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- Authors
- Wang, Q. Q., Kaelber, D. C., Xu, R., & Volkow, N. D.
- Affiliations
- Case Western Reserve University (US)
- MetroHealth (US)
- National Institutes of Health (US)
- Corresponding author
- Xu, Rong
- Volkow, Nora D.
- Venue
- Molecular Psychiatry
- Published
- 2020-09-14
- Volume
- 26
- Issue
- 1
- Pages
- 30-39
- ISSN
- 1359-4184 (ISSN-L)
- 1476-5578
- PMC
- PMC7488216
- OpenAlex
- W3086642606
- Cited by
- 634
- References
- 27
- Citations by year
- 2026: 18 · 2025: 34 · 2024: 89 · 2023: 114 · 2022: 180 · 2021: 177 · 2020: 20
- FWCI
- 16.08
- Type
- journal article
- Language
- en
- Update notices
- correction (2020-09-30)
- Open access
- bronze
- doi.org
- Locations
- Molecular Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Scholarly Commons @ Case Western Reserve University (submittedVersion, other-oa)
- HRB National Drugs Library (Health Research Board) (submittedVersion)
- Funders
- U.S. Department of Health & Human Services | NIH | National Institute on Aging (AG061388, AG062272)
- American Cancer Society (RSG-16-049-01)
- U.S. Department of Health & Human Services | NIH | National Center for Advancing Translational Sciences (1UL1TR002548-01)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Keywords
- COVID-19 pandemic, substance use disorders, opioid use disorder, tobacco use disorder, racial disparities, African Americans, COVID-19 mortality, hospitalization, comorbid chronic disease, health disparities, electronic health records, health equity policy, substance use disorder treatment access, health workforce retention
- MeSH terms
- COVID-19, SARS-CoV-2, Black or African American, Hospitalization, Humans, Retrospective Studies, Risk Factors, United States, Comorbidity, Case-Control Studies, Substance-Related Disorders, White People, Electronic Health Records, Pandemics
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