COVID-19 complications among patients with opioid use disorder: a retrospective cohort study across five major NYC hospital systems

Noa Krawczyk; Bianca D Rivera; Cale Basaraba; Thomas Corbeil; Bennett Allen; Katharina Schultebraucks; Brandy F Henry; Harold A Pincus; Frances R Levin; Diana Martinez

doi:10.1111/add.16105

COVID-19 complications among patients with opioid use disorder: a retrospective cohort study across five major NYC hospital systems

Addiction. 2023 May;118(5):857-869. doi: 10.1111/add.16105. Epub 2023 Jan 8.

Authors

Affiliations

¹ Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
² Area Mental Health Data Science, New York State Psychiatric Institute, New York, NY, USA.
³ Department of Emergency Medicine, Columbia University, New York, NY, USA.
⁴ College of Education, The Pennsylvania State University, University Park, PA, USA.
⁵ Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University and New York State Psychiatric Institute, New York, NY, USA.

Abstract

Background and aims: Individuals with opioid use disorder (OUD) suffer disproportionately from COVID-19. To inform clinical management of OUD patients, research is needed to identify characteristics associated with COVID-19 progression and death among this population. We aimed to investigate the role of OUD and specific comorbidities on COVID-19 progression among hospitalized OUD patients.

Design: Retrospective cohort study of merged electronic health records (EHR) from five large private health systems.

Setting: New York City, New York, USA, 2011-21.

Participants: Adults with a COVID-19 encounter and OUD or opioid overdose diagnosis between March 2020 and February 2021.

Measurements: Primary exposure included diagnosis of OUD/opioid overdose. Risk factors included age, sex, race/ethnicity and common medical, substance use and psychiatric comorbidities known to be associated with COVID-19 severity. Outcomes included COVID-19 hospitalization and subsequent intubation, acute kidney failure, severe sepsis and death.

Findings: Of 110 917 COVID-19+ adults, 1.17% were ever diagnosed with OUD/opioid overdose. OUD patients had higher risk of COVID-19 hospitalization [adjusted risk ratio (aRR) = 1.40, 95% confidence interval (CI) = 1.33, 1.47], intubation [adjusted odds ratio (aOR) = 2.05, 95% CI = 1.74, 2.42], kidney failure (aRR = 1.51, 95% CI = 1.34, 1.70), sepsis (aRR = 2.30, 95% CI = 1.88, 2.81) and death (aRR = 2.10, 95% CI = 1.84, 2.40). Among hospitalized OUD patients, risks for worse COVID-19 outcomes included being male; older; of a race/ethnicity other than white, black or Hispanic; and having comorbid chronic kidney disease, diabetes, obesity or cancer. Protective factors included having asthma, hepatitis-C and chronic pain.

Conclusions: Opioid use disorder patients appear to have a substantial risk for COVID-19-associated morbidity and mortality, with particular comorbidities and treatments moderating this risk.

Keywords: COVID-19; data linkage; disparities; hospital care; opioid use disorder.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Adult
COVID-19* / epidemiology
Female
Hospitals
Humans
Male
New York City / epidemiology
Opiate Overdose* / epidemiology
Opioid-Related Disorders* / drug therapy
Retrospective Studies

Abstract

Publication types

MeSH terms

Grants and funding