Mental Health and Substance Use Associated with Hospitalization among People with COVID-19: A Population-Based Cohort Study

  1. Héctor Alexander Velásquez García
  2. James Wilton
  3. Kate Smolina
  4. Mei Chong
  5. Drona Rasali
  6. Michael Otterstatter
  7. Caren Rose
  8. Natalie Prystajecky
  9. Samara David
  10. Eleni Galanis
  11. Geoffrey McKee
  12. Mel Krajden
  13. Naveed Zafar Janjua

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Abstract

This study identified factors associated with hospital admission among people with laboratory-diagnosed COVID-19 cases in British Columbia. The study used data from the BC COVID-19 Cohort, which integrates data on all COVID-19 cases with data on hospitalizations, medical visits, emergency room visits, prescription drugs, chronic conditions and deaths. The analysis included all laboratory-diagnosed COVID-19 cases in British Columbia to 15 January 2021. We evaluated factors associated with hospital admission using multivariable Poisson regression analysis with robust error variance. Of the 56,874 COVID-19 cases included in the analysis, 2298 were hospitalized. Factors associated with increased hospitalization risk were as follows: male sex (adjusted risk ratio (aRR) = 1.27; 95% CI = 1.17–1.37), older age (p-trend < 0.0001 across age groups increasing hospitalization risk with increasing age [aRR 30–39 years = 3.06; 95% CI = 2.32–4.03, to aRR 80+ years = 43.68; 95% CI = 33.41–57.10 compared to 20–29 years-old]), asthma (aRR = 1.15; 95% CI = 1.04–1.26), cancer (aRR = 1.19; 95% CI = 1.09–1.29), chronic kidney disease (aRR = 1.32; 95% CI = 1.19–1.47), diabetes (treated without insulin aRR = 1.13; 95% CI = 1.03–1.25, requiring insulin aRR = 5.05; 95% CI = 4.43–5.76), hypertension (aRR = 1.19; 95% CI = 1.08–1.31), injection drug use (aRR = 2.51; 95% CI = 2.14–2.95), intellectual and developmental disabilities (aRR = 1.67; 95% CI = 1.05–2.66), problematic alcohol use (aRR = 1.63; 95% CI = 1.43–1.85), immunosuppression (aRR = 1.29; 95% CI = 1.09–1.53), and schizophrenia and psychotic disorders (aRR = 1.49; 95% CI = 1.23–1.82). In an analysis restricted to women of reproductive age, pregnancy (aRR = 2.69; 95% CI = 1.42–5.07) was associated with increased risk of hospital admission. Older age, male sex, substance use, intellectual and developmental disability, chronic comorbidities, and pregnancy increase the risk of COVID-19-related hospitalization.

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  1. Version published to 10.3390/v13112196
  2. ScreenIT

    SciScore for 10.1101/2021.08.26.21262697: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: This study was reviewed and approved by the Behavioral Research Ethics Board at the University of British Columbia (approval # H20-02097).
    Sex as a biological variableFor women of reproductive age (15-49 years), hospital admissions related to COVID-19 were considered as such only if no obstetric-related hospitalization code was found in DAD, within 14 days of hospital admission (Appendix D).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our analysis had several limitations. We relied on administrative data to identify patient characteristics and co-morbidities; this may have led to some level of misclassification. Similarly, for the same reason, it is not possible to evaluate clinical severity of the event leading to hospital admission. Further, we did not have information on socioeconomic status, race/ethnicity, and obesity. Also, given that the evaluation of the COVID-19 status depends on the BC diagnostic testing guidelines (varying over time to focus on symptom-based assessment since April 21st, 2020),29 selective ascertainment of symptomatic cases is expected, resulting in exclusion of asymptomatic cases.30 In conclusion, older age, male sex, pregnancy, and various comorbidities and health-conditions including substance use were associated with higher risk of hospital admission in this population-based analysis. These findings have informed the COVID-19 vaccination program rollout in BC and will be useful for informing the prioritization of vaccination in other jurisdictions to prevent infection and severe outcomes.13 In addition, these findings will also inform monitoring of individual patients by their healthcare providers at higher risk of severe outcomes. Finally there is a need for further characterizing syndemics of substance use, mental illness and COVID-19.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2021.08.26.21262697v1 on medRxiv