Alcohol Use and COVID-19 Outcomes.

Abstract

Background: There is increasing recognition that health behaviors may contribute to outcomes following COVID-19, but information on the role of alcohol use is limited.

Research question: Are different severity levels of pre-existing alcohol use disorder (AUD), alcohol consumption, and their combination associated with 30-day COVID-19 outcomes?

Study design and methods: Utilizing data from a US national cohort (Veterans Administration), we determined the risk associated with AUD, based on diagnostic codes including alcohol abuse, alcohol dependence, and alcohol-related disease (ARD) for COVID-19-related outcomes: mild (outpatient management), moderate (hospitalization), critical (hospitalization with indicators of critical illness), or death. We determined the modification of this risk for different levels of self-reported alcohol consumption using categories defined by an alcohol-use screening tool (Alcohol Use Disorders Identification Test Consumption Questions: AUDIT-C).

Results: Out of a total of 463,246 COVID-19+ veterans, those with every severity of AUD (abuse, dependence, ARD) had a lower probability of a mild outcome (adjusted risk ratio (aRR) range=0.75 - 0.98) and greater probability of hospitalization (range aRR=1.14-2.50) compared to Veterans with no AUD for every level of alcohol consumption. This lower likelihood of a mild outcome and higher likelihood of hospitalization increased with the severity of AUD. Veterans with alcohol dependence had increased probability for critical outcome, but only for high consumption (aRR=1.28). Veterans with ARD had a higher probability of a critical outcome and death within every level of consumption (ranges aRR=1.32-2.01 and aRR=1.58-1.91 respectively) with the highest probability seen at high-risk consumption levels.

Interpretation: Overall, alcohol use disorders were associated with poorer COVID-19 outcomes. The likelihood of negative outcome generally increased with increasing severity of AUD. The association between the risk of AUD and negative outcome was modified by alcohol consumption, with the poorest outcomes seen with both AUD and high-risk drinking.