JMIR Public Health Surveill. 2021 Oct 14. doi: 10.2196/33022. Online ahead of print.
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 that took place between January 1, 2020 and December 31, 2020, 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 10th Revision (ICD-10) codes to identify patients with UAU. After controlling for age, sex, ethnicity, BMI, smoking status, insurance status, and presence of ICD-10 codes for cancer, cardiovascular disease, and diabetes, 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 with 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). We found that patients in the unhealthy alcohol group had a greater odds risk to develop more severe disease (Odds ratio = 1.89, 95% confidence interval: 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.