29/03/2023
Bill read this in Infectious Disease advisor. authorbillbutler.com
PLEUROPULMONARY AND BRONCHIAL INFECTIONS
COVID-19 Hospitalization Linked With Substance Use, Psychiatric Disorders in COVID-19
Ron Goldberg | March 28, 2023
Hospitalization is more likely for patients with COVID-19 who have psychiatric disorders and substance abuse disorders.
A greater likelihood of hospitalization exists for patients with COVID-19 and with both psychiatric disorder (PD) and substance use disorder (SUD) compared with individuals with COVID-19 and with neither disorder or with either disorder alone, according to study findings published in the Journal of the American Medical Association Psychiatry.
Investigators sought to evaluate the association of comorbid PD and SUD with the probability of hospitalization among patients with COVID-19 in the emergency department (ED). The primary endpoint was any hospitalization determined by billing codes .
They conducted a retrospective cross-sectional study that included more than 1.2 million patients with COVID-19 treated in 1 of 970 US EDs and inpatient hospitals from April 2020 to August 2021. Primary exposures were any past diagnosis of PD (posttraumatic stress disorder (PTSD), major depression or other mood disorder, bipolar disorder, anxiety, attention-deficit/hyperactivity disorder [ADHD], or schizophrenia) and/or SUD (co***ne, sedatives, cannabis, alcohol, stimulants, opioids or other substances). Investigators calculated differences in the probability of hospitalization to evaluate its association with both SUD and PD compared with SUD alone, PD alone, or neither condition. Ni****ne dependence was treated as a comorbid covariate vs a primary exposure variable. Independent variables consisted of s*x, race and ethnicity, age, primary insurance, and the US Census region of the hospital.
Investigators analyzed discharge data using the Premier PINC AI Healthcare Data Special Release COVID-19 (PHD-SR COVID-19) edition (release date, September 14, 2021), a 48-state, all-payer longitudinal electronic health record database that included 1,274,219 adult patients with COVID-19 at least 18 years of age (mean age, 54.6±19.1 years; 52.4% women) and found 4.6% had an SUD (mean age, 50.1 years; 38.3% women), 18.6% had a PD (mean age 59.0 years; 62.3% women), and 2.3% had both (mean age, 50.4 years; 46.9% women).
Substance use disorders appear to have a greater association than psychiatric disorders with the probability of hospitalization.
There were 567,766 (44.6%) of patients hospitalized directly from the ED. Hospitalized patients vs those not admitted were more likely men (52.4%), older (mean age 63.6 vs 47.4 years), insured by Medicare, living in urban areas, or living in the Northeast census region. Among the hospitalized patients, about three-fourths had a chronic disease vs one-third of patients with COVID-19 who were discharged from an ED.