Association of substance use disorders and drug overdose with adverse COVID-19 outcomes in New York City: January-October 2020

J Public Health (Oxf). 2021 Sep 22;43(3):462-465. doi: 10.1093/pubmed/fdaa241.


Background: Evidence suggests that individuals with history of substance use disorder (SUD) are at increased risk of COVID-19, but little is known about relationships between SUDs, overdose and COVID-19 severity and mortality. This study investigated risks of severe COVID-19 among patients with SUDs.

Methods: We conducted a retrospective review of data from a hospital system in New York City. Patient records from 1 January to 26 October 2020 were included. We assessed positive COVID-19 tests, hospitalizations, intensive care unit (ICU) admissions and death. Descriptive statistics and bivariable analyses compared the prevalence of COVID-19 by baseline characteristics. Logistic regression estimated unadjusted and sex-, age-, race- and comorbidity-adjusted odds ratios (AORs) for associations between SUD history, overdose history and outcomes.

Results: Of patients tested for COVID-19 (n = 188 653), 2.7% (n = 5107) had any history of SUD. Associations with hospitalization [AORs (95% confidence interval)] ranged from 1.78 (0.85-3.74) for cocaine use disorder (COUD) to 6.68 (4.33-10.33) for alcohol use disorder. Associations with ICU admission ranged from 0.57 (0.17-1.93) for COUD to 5.00 (3.02-8.30) for overdose. Associations with death ranged from 0.64 (0.14-2.84) for COUD to 3.03 (1.70-5.43) for overdose.

Discussion: Patients with histories of SUD and drug overdose may be at elevated risk of adverse COVID-19 outcomes.

Keywords: COVID-19; drug overdose; substance use disorder.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • COVID-19*
  • Comorbidity
  • Drug Overdose* / epidemiology
  • Humans
  • New York City / epidemiology
  • Retrospective Studies
  • SARS-CoV-2
  • Substance-Related Disorders* / epidemiology