Abstract
Introduction: People with substance use disorder (SUD) may be at increased risk of COVID-19 infection. However, there is little evidence regarding the incidence of and determinants associated with infection in this group. The aims of the study were to determine the cumulative incidence of COVID-19 among people who sought treatment for heroin, cocaine, cannabis, and alcohol use disorder in Catalonia; to identify sociodemographic, substance, and clinical determinants associated with COVID-19 infection among SUD patients; and to compare the cumulative incidence of COVID-19 infection in the population with SUD with that of the general population. Methods: A patient-based retrospective observational study was conducted. The study population comprised people who sought treatment for heroin, cocaine, cannabis, or alcohol use disorder in Catalonia in 2018 and 2019. We analysed cumulative incidence of COVID-19 (confirmed by PCR test) from 25 February to 31 December 2020. Additionally, we used a log-link binomial generalized linear model for COVID-19 infection, using the substance as the exposition, adjusting for sociodemographic and clinical variables. Results: Of the 23,092 individuals who sought treatment for SUD, 38.15% were considered suspected cases of COVID-19, and 2.60% (95% CI = 2.41–2.82) were confirmed positive for COVID-19 by PCR test during the study period. Those who sought treatment for alcohol use (cumulative incidence of COVID-19 of 3% [95% CI = 2.70–3.34]) had a higher risk ratio than, those who sought treatment for heroin use (cumulative incidence of 1.94% [95% CI = 1.47–2.56]). Being born outside of Spain, living in an institutionalized residence, having HIV, and being in a high morbidity group were associated with higher risk of COVID-19 infection. Meanwhile, the cumulative incidence of COVID-19 in the general population, according to public COVID-19 test data, was 3.86% (95% CI = 3.85–3.87). Conclusion: This study did not find higher cumulative incidence of COVID-19 infection among people with SUD in Catalonia in 2020, despite the clinical vulnerability of this population and their social disadvantage. However, differences were seen in the cumulative incidence of COVID-19 according to the substance for which treatment was sought. For example, those with alcohol dependence had a higher rate than those dependent on heroin. Further studies are needed to determine the factors contributing to these differences.
Journal Section:
Research Article
References
1.
Zhu
N
, Zhang
D
, Wang
W
, Li
X
, Yang
B
, Song
J
. A novel coronavirus from patients with pneumonia in China, 2019
. N Engl J Med
. 2020
;382
(8
):727
–33
.2.
Working group for the surveillance and control of COVID-19 in Spain
Members of the Working group for the surveillance and control of COVID-19 in Spain
Martínez Sánchez
EV
, Lorusso
N
, Ubago Carmona
A
, Gallardo Garcia
V
. The first wave of the COVID-19 pandemic in Spain: characterisation of cases and risk factors for severe outcomes, as at 27 April 2020
. Euro Surveill
. 2020
;25
(50
):2001431
.3.
Instituto de Salud Carlos III (ISCIII)
Informe sobre los casos de COVID-19 confirmados en España Informe COVID-19 no 3. [Report on confirmed COVID-19 cases in Spain. COVID-19 report no 3]
Madrid
ISCIII
2020
. Spanish. Available from: https://www.isciii.es/QueHacemos/Servicios/VigilanciaSaludPublicaRENAVE/EnfermedadesTransmisibles/Documents/INFORMES/Informes%20COVID-19/Informe%20COVID-19.%20N%c2%ba%203_28febrero2020_ISCIII.pdf.4.
European Centre for Disease Prevention and Control (ECDC)
COVID-19 situation update worldwide, as of week 7, updated 25 February 2021
. 2021
.5.
Secretaria General de Sanidad
Actualización no 524. Enfermedad por el coronavirus (COVID-19) [Internet]
Ministerio de Sanidad - Gobierno de España
2021
. Available at: https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/documentos/Actualizacion_44_COVID_1200.pdf.6.
Burn
E
, Tebé
C
, Fernandez-Bertolin
S
, Aragon
M
, Recalde
M
, Roel
E
. The natural history of symptomatic COVID-19 during the first wave in Catalonia
. Nat Commun
. 2021
;12
(1
):777
–12
. Available at: http://dx.doi.org/10.1038/s41467-021-21100-y.7.
Friedman
H
, Newton
C
, Klein
TW
. Microbial infections, immunomodulation, and drugs of abuse
. Clin Microbiol Rev
. 2003
;16
(2
):209
–19
.8.
Friedman
H
, Pross
S
, Klein
TW
. Addictive drugs and their relationship with infectious diseases
. FEMS Immunol Med Microbiol
. 2006
;47
(3
):330
–42
.9.
Bahorik
AL
, Satre
DD
, Kline-Simon
AH
, Weisner
CMC
, Campbell
CI
. Alcohol, cannabis, and opioid use disorders, and diseaseburden in an integrated health care system
. J Addict Med
. 2017
;11
(1
):3
–9
.10.
Lin
Z
. Mechanisms for substance use disorders in COVID-19
. Mol Psychiatry
. 2021
;26
(9
):4568
–9
. Available at: http://dx.doi.org/10.1038/s41380-021-01041-0.11.
Richardson
S
, Hirsch
JS
, Narasimhan
M
, Crawford
JM
, McGinn
T
, Davidson
KW
. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area
. JAMA
. 2020
;323
(20
):2052
–9
.12.
Wei
Y
, Shah
R
. Substance use disorder in the COVID-19 pandemic: a systematic review of vulnerabilities and complications
. Pharmaceuticals
. 2020
;13
(7
):155
–29
.13.
Wang
QQ
, Kaelber
DC
, Xu
R
, Volkow
ND
. COVID-19 risk and outcomes in patients with substance use disorders: analyses from electronic health records in the United States
. Mol Psychiatry
. 2021
;26
(1
):30
–9
. Available at: http://dx.doi.org/10.1038/s41380-020-00880-7.14.
Baillargeon
J
, Polychronopoulou
E
, Kuo
YF
, Raji
MA
. The impact of substance use disorder on COVID-19 outcomes
. Psychiatr Serv
. 2021
;72
(5
):578
–81
.15.
Volkow
ND
. Collision of the COVID-19 and addiction epidemics
. Ann Intern Med
. 2020
;173
(1
):61
–2
.16.
Jaen
A
, Casabona
J
, Esteve
A
, Miró
JM
, Tural
C
, Ferrer
E
. Clinical-epidemiological characteristics and antiretroviral treatment trends in a cohort of HIV infected patients. The PISCIS Project
. Med Clin
. 2005
;124
(14
):525
–31
.17.
López-Casasnovas
G
, Ruiz-Muñoz
D
, Colls
C
, Mias
M
, Bassols
NM
. Socioeconomic inequalities in health and the use of healthcare services in Catalonia: analysis of the individual data of 7.5 million residents
. J Epidemiol Community Health
. 2019
;73
(2
):97
–9
.18.
Carrilero
N
, Dalmau-Bueno
A
, García-Altés
A
. Socioeconomic inequalities in 29 childhood diseases: evidence from a 1,500,000 children population retrospective study
. BMC Public Health
. 2021
;21
(1
):1150
–14
.19.
Cerezo
J
, Arias
C
. Population stratification: a fundamental instrument used for population health management in Spain
. In: Good practice Brief.Regional office of Europe
World Health Organization (WHO)
2018
.20.
Dueñas-Espín
I
, Vela
E
, Pauws
S
, Bescos
C
, Cano
I
, Cleries
M
. Proposals for enhanced health risk assessment and stratification in an integrated carescenario
. BMJ Open
. 2016
;6
(4
):e010301
.21.
Instituto de salud Carlos III
Estrategia de detección precoz, vigilancia y control de COVID-19 [Internet]
Ministerio de Sanidad - Gobierno de España
2020
. Available at: https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/documentos/COVID19_Estrategia_vigilancia_y_control_e_indicadores.pdf.22.
Blizzard
L
, Hosmer
DW
. Parameter estimation and goodness-of-fit in log binomial regression
. Biom J
. 2006
;48
(1
):5
–22
.23.
Volkow
ND
. Stigma and the toll of addiction
. N Engl J Med
. 2020
;382
(14
):1289
–90
.24.
Chen
IM
, Huang
CLC
, Yeh
BJ
, Chien
YL
. Health service utilization of heroin abusers: a retrospective cohort study
. Addict Behav
. 2015
;45
:281
–6
.25.
Rudd
RA
, Seth
P
, David
F
, Scholl
L
. Morbidity and mortality weekly report increases in drug and opioid-involved overdose
. Deaths – United States
. 2010
;65
:2010
–5
.26.
March Cerda
JC
, Oviedo-joekes
E
, Romero-Vallecillos
M
, Sanchez-Cantalejo
E
. Factores asociados al uso de la via pulmonar e intravenosa en una muestra de consumidores de heroina en Granada
. Rev Esp Salud Publica
. 2005
;79
(3
):391
–401
.27.
Benzano
D
, Ornell
F
, Bohrer
J
, Pechansky
F
. Clinical vulnerability for severity and mortality by COVID-19 among users of alcohol and other substances
. Psychiatry Res
. 2020
.28.
Rehm
J
, Gmel
GE
, Gmel
G
, Hasan
OSM
, Imtiaz
S
, Popova
S
. The relationship between different dimensions of alcohol use and the burden of disease: an update
. Addiction
. 2017
;112
(6
):968
–1001
.29.
Webb-Hopper
M
, Napoles
AM
, Perez-Estable
EJ
. COVID-19 and racial-ethnic disparities
. JAMA
. 2020
.30.
Kjøllesdal
M
, Skyrud
K
, Gele
A
, Arnesen
T
, Kløvstad
H
, Diaz
E
. The correlation between socioeconomic factors and COVID-19 among immigrants in Norway: a register-based study
. Scand J Public Health
. 2022
;50
(1
):52
–60
.31.
Hoebel
J
, Grabka
MM
, Schröder
C
, Haller
S
, Neuhauser
H
, Wachtler
B
. Socioeconomic position and SARS-CoV-2 infections: seroepidemiological findings from a German nationwide dynamic cohort
. J Epidemiol Community Health
. 2021
;76
(4
):350
–3
.32.
Yancy
CW
. COVID-19 and african Americans
. JAMA
. 2020
;323
(19
):1891
–2
.33.
Tsai
J
, Wilson
M
. COVID-19: a potential public health problem for homeless populations
. Lancet Public Health
. 2020
;5
(4
):e186
–7
.34.
Hwang
SW
, Ueng
JJM
, Chiu
S
, Kiss
A
, Tolomiczenko
G
, Cowan
L
. Universal health insurance and health care access for homeless persons
. Am J Public Health
. 2010
;100
(8
):1454
–61
.35.
Storgaard
SF
, Eiset
AH
, Abdullahi
F
, Wejse
C
. First wave of COVID-19 did not reach the homeless population in Aarhus
. Dan Med J
. 2020
;67
(12
):1
–7
.36.
April
M
, Page
L
, Mcmichael
TM
, Keating
R
, Marx
GE
, Andrews
T
. Assessment of SARS-CoV-2 infection prevalence in homeless shelters: four US cities
. MMWR Morb Mortal Wkly Rep
. 2020
;69
(17
):1
–2
.37.
Baggett
TP
, Keyes
H
, Sporn
N
, Gaeta
JM
. Prevalence of SARS-CoV-2 infection in residents of a large homeless shelter in Boston
. JAMA
. 2020
;323
(21
):2191
–2
.38.
Barocas
JA
, Blackstone
E
, Bouton
TC
, Kimmel
SD
, Caputo
A
, Porter
SJ
. Prevalence of covid-19 infection and subsequent cohorting in a residential substance use treatment Program in boston, MA
. J Addict Med
. 2020
;14
(5
):e261
–3
.39.
Kinner
SA
, JesseYoung
TKS
, Louise Southalan
DLA
, Ferreira-Borges
CÉO
. Prisons and custodial settings are part of a comprehensive response to COVID-19
. Lancet Public Health
. 2020
;5
(4
):e188
–e9
.40.
Nomah
DK
, Reyes-Urueña
J
, Díaz
Y
, Moreno
S
, Aceiton
J
, Bruguera
A
. Sociodemographic, clinical, and immunological factors associated with SARS-CoV-2 diagnosis and severe COVID-19 outcomes in people living with HIV: a retrospective cohort study
. Lancet HIV
. 2021
;8
(11
):701
–10
.41.
Allen
B
, El Shahawy
O
, Rogers
ES
, Hochman
S
, Khan
MR
, Krawczyk
N
. Association of substance use disorders and drug overdose with adverse COVID-19 outcomes in New York City: January–October 2020
. J Public Health
. 2021
;43
(3
):462
–5
.42.
Vallecillo
G
, Perelló
R
, Güerri
R
, Fonseca
F
, Torrens
M
. Clinical impact of COVID-19 on people with substance use disorders
. J Public Health
. 2021
;43
(1
):9
–12
.© 2023 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2023
You do not currently have access to this content.
