After COVID-19 infection, compared with non-COVID-19 respiratory infections, elevated risk for alcohol use disorders (AUD) suggests an association between SARS-CoV-2 infection and the increase in AUD, but that association may be attenuated by fear and anxiety in circumstances surrounding the pandemic, according to study findings published in the Journal of the American Medical Association Network Open.
Investigators sought to assess the association of COVID-19 infection from January 2020 through January 2022 with the risk for a new diagnosis of AUD across 3-month interval blocks.
Electronic health records in the TriNetX Analytics Platform (more than 60 million deidentified patients in 34 health care organizations in the US) were used to identify 2.8 million US patients at least 12 years of age with COVID-19 or other respiratory infections from January 2020 to January 2022. Investigators conducted this retrospective, observational cohort study in which new diagnoses of AUD were compared between patients with COVID-19 and patients with other respiratory infections (all patients identified with ICD-10 codes) but never previously infected with COVID-19.
Based on the time of COVID-19 infection, comparisons were made in 3-month intervals beginning January 2020. Patients who died before the follow-up analysis began (14 days after the last day of the respective index event window) were excluded as were patients with an encounter diagnosis of AUD before the follow-up window. Sensitivity was tested with bone fracture as a control index event.
COVID-19 cohorts and the other respiratory cohorts were matched for COVID-19 vaccination (starting in block 4), hospitalization, substance use disorders, mental health disorders that commonly occur with substance use disorders, family history of substance use, demographic characteristics, other risk factors for greater severity of illness from COVID-19, and socioeconomic status.
Investigators included 1.2 million patients with COVID-19 (mean age at index, 46.2±18.9 years; 57% women; 66% White) and 1.6 million patients with other respiratory infections who had never had COVID-19 (mean age at index, 44.5±20.6 years; 60% women; 71% White). After matching (N=1,904,952) there were 952,476 patients in the COVID-19 cohorts and the same number in the other respiratory cohorts.
COVID-19 cases in each block increased across blocks 1 through 4, decreased in blocks 5 and 6, and increased significantly in blocks 7 and 8 (consistent with COVID-19 cases reported by the CDC across those times).
In the first 3-month interval (block 1) they found a significantly increased risk for new diagnosis of AUD in the immediate 3 months after the patients contracted COVID-19 vs the control cohort (119 of 30,250 patients [0.4%] in the COVID-19 cohort; 50 of 30,250 patients [0.2%] in the other respiratory cohort) (hazard ratio [HR], 2.53; 95% CI, 1.82-3.51). The risk became nonsignificant in the next 3 time-blocks (April 2020 to January 2021).
In the immediate 3 months after COVID-19 infection, the risk for AUD diagnosis increased in block 5, January 2021 to April 2021 (HR, 1.30; 95% CI, 1.08-1.56) and in block 6, April 2021 to July 2021 (HR, 1.80; 95% CI, 1.47-2.21). The risk became nonsignificant in blocks 7 (HR, 1.17; 95% CI, 0.98-1.40) and 8 (HR, 1.14; 95% CI, 0.97-1.33) (COVID-19 diagnosis between July 2021 and January 2022).
Investigators noted that the risk for AUD diagnosis 3 to 6 months after COVID-19 infection vs control index events revealed a similar temporal pattern to the risk in the first 3 months.
Study limitations include the observational retrospective design, errors and missing relevant data in electronic health records, and increasing availability of home testing leading to misclassification over time. Additional limitations include TriNetX population not being representative of the US population, and AUD defined by ICD-10 code F10 only (alcohol abuse and alcohol dependence are not included in this analysis).
Investigators concluded “An excess risk of a new diagnosis of AUD with COVID-19 was observed in the beginning of the pandemic, which then subsided, increased again for infections contracted from January to July 2021, and then became nonsignificant again after August 2021.” They wrote “The results of this study suggest that the risk of a new diagnosis of AUD after a COVID-19 diagnosis may not be a consequence of the infection itself.” They added “The lack of excess hazard in most time blocks makes it likely that the circumstances surrounding the pandemic and the fear and anxiety they created also were important factors associated with new diagnoses of AUD.”
Olaker VR, Kendall EK, Wang CX, et al. Association of recent SARS-CoV-2 infection with new-onset alcohol use disorder, January 2020 through January 2022. JAMA Netw Open. Published online February 1, 2023. doi:10.1001/jamanetworkopen.2022.55496