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Mental Health and Substance Use Associated with Hospitalization among People with COVID-19: A Population-Based Cohort
Héctor Alexander Velásquez García1,2, James Wilton1, Kate Smolina1,2
1British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada.
Insights
Older age, male sex, and certain medical conditions like diabetes and cancer significantly increase COVID-19 hospitalization risk. Pregnancy also elevates the risk for women of reproductive age.
Area of Science:
- Public Health
- Epidemiology
- Infectious Disease Research
Background:
- The COVID-19 pandemic necessitated understanding risk factors for severe disease, particularly hospital admission.
- Identifying vulnerable populations is crucial for targeted public health interventions and resource allocation.
Purpose of the Study:
- To identify demographic, clinical, and socioeconomic factors associated with hospital admission among laboratory-diagnosed COVID-19 cases in British Columbia.
- To quantify the risk of hospitalization associated with various comorbidities and demographic characteristics.
Main Methods:
- Utilized the BC COVID-19 Cohort, integrating comprehensive health data for laboratory-diagnosed COVID-19 cases up to January 15, 2021.
- Employed multivariable Poisson regression analysis to evaluate factors associated with hospital admission.
- Included over 56,000 COVID-19 cases in the analysis, with 2298 hospitalizations.
Main Results:
- Older age, male sex, asthma, cancer, chronic kidney disease, diabetes, hypertension, injection drug use, intellectual/developmental disabilities, problematic alcohol use, immunosuppression, and schizophrenia were associated with increased hospitalization risk.
- Pregnancy was a significant risk factor for hospital admission in women of reproductive age.
- Adjusted risk ratios indicated substantial increases in hospitalization risk for older age groups and individuals with diabetes requiring insulin and injection drug use.
Conclusions:
- Older age, male sex, substance use, intellectual and developmental disability, chronic comorbidities, and pregnancy are key factors associated with increased risk of COVID-19-related hospitalization.
- Findings highlight the need for tailored preventive strategies and healthcare management for high-risk individuals.
- The study underscores the complex interplay of factors contributing to severe COVID-19 outcomes.
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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