Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Aug 18, 2021
Open Peer Review Period: Aug 18, 2021 - Sep 2, 2021
Date Accepted: Oct 14, 2021
Date Submitted to PubMed: Oct 19, 2021
(closed for review but you can still tweet)
Unhealthy alcohol use is an independent risk factor for increased COVID-19 disease severity: observational cross-sectional study
ABSTRACT
Background:
Unhealthy alcohol use (UAU) is known to disrupt pulmonary immune mechanisms and increase the risk of acute respiratory distress syndrome in patients with pneumonia; however, little is known about the effects of UAU on outcomes in patients with COVID-19 pneumonia. To our knowledge, this is the first observational cross-sectional study that aims to understand the effect of UAU on the severity of COVID-19 disease.
Objective:
We aim to determine if UAU is associated with more severe clinical presentation and worse health outcomes related to COVID-19 and if socioeconomic status, smoking, age, body mass index (BMI), race/ethnicity, and pattern of alcohol use modify the risk.
Methods:
In this observational cross-sectional study, we ran a digital machine learning classifier on the electronic health record of patients who tested positive via nasopharyngeal swab for SARS-CoV-2 or had two COVID-19 international classification of disease codes to identify patients with UAU. We then performed a multivariable regression to examine the relationship between UAU and COVID-19 severity as measured by hospital care level, i.e. emergency department admission, emergency department admission with ventilator, or death. We used a predefined cutoff of 0.15 (optimal sensitivity and specificity) on the digital classifier to compare disease severity in patients with versus without UAU. Models were adjusted for age, sex, race/ethnicity, BMI, smoking status, and insurance status.
Results:
Each incremental increase in the predicted probability from the digital alcohol classifier was associated with a greater odds risk for more severe COVID-19 disease(OR 1.15, 95% CI: 1.10 - 1.20). Using the predefined cut-off of 0.15 to group patients into binary unhealthy alcohol group or not, we found that the unhealthy alcohol group had a greater odds risk to develop more severe disease (OR = 1.89, 95% CI: 1.17 - 3.06), suggesting that alcohol positive classification was associated with a 89% increase in the odds of being in a higher severity category.
Conclusions:
In patients infected with SARS-CoV-2, UAU is an independent risk factor associated with greater disease severity and/or death.
Citation
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