@Article{info:doi/10.2196/33022,
author="Bhalla, Sameer
and Sharma, Brihat
and Smith, Dale
and Boley, Randy
and McCluskey, Connor
and Ilyas, Yousaf
and Afshar, Majid
and Balk, Robert
and Karnik, Niranjan
and Keshavarzian, Ali",
title="Investigating Unhealthy Alcohol Use As an Independent Risk Factor for Increased COVID-19 Disease Severity: Observational Cross-sectional Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Nov",
day="5",
volume="7",
number="11",
pages="e33022",
keywords="unhealthy alcohol use; COVID-19; SARS-CoV-2; acute respiratory distress syndrome; substance misuse; mechanical ventilation; substance use",
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. 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, 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 for SARS-CoV-2 via nasopharyngeal swab 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 (ie, 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 and 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 (odds ratio 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{\%} CI 1.17-3.06), suggesting that UAU was associated with an 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. ",
issn="2369-2960",
doi="10.2196/33022",
url="https://publichealth.jmir.org/2021/11/e33022",
url="https://doi.org/10.2196/33022",
url="http://www.ncbi.nlm.nih.gov/pubmed/34665758"
}