Mental Health and Substance Use Associated with Hospitalization among People with COVID-19: A Population-Based Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Comorbidities
2.3. Statistical Analysis
3. Results
3.1. Demographic and Clinical Characteristics
3.2. Chronic Comorbidities as Risk Factors
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Disclaimer
References
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Variable | Category | Total * n = 56,874 | Non-Hospitalized ⁰ n = 54,576 | Hospitalized ⁰ n = 2298 | Hospitalized Row % | Crude Incidence Rate Ratio (95% Conf. Interv.) | p† |
---|---|---|---|---|---|---|---|
Sex | Female | 27,769 (48.8%) | 26,816 (49.1%) | 953 (41.5%) | 3.4% | Reference | <0.0001 |
Male | 29,105 (51.2%) | 27,760 (50.9%) | 1345 (58.5%) | 4.6% | 1.35 (1.24–1.46) | ||
Age (years) | N/A | 36 (28) ⁱ | 35 (26) ⁱ | 66 (25) ⁱ | - | 1.07 (1.06–1.07) | <0.0001 |
Age group ‡ | <20 years | 7683 (13.5%) | 7665 (14.0%) | 18 (0.8%) | 0.2% | 0.45 (0.27–0.77) | 0.0031 |
20–29 years | 13,490 (23.7%) | 13,421 (24.6%) | 69 (3.0%) | 0.5% | Reference | - | |
30–39 years | 10,681 (18.8%) | 10,507 (19.3%) | 174 (7.6%) | 1.6% | 3.18 (2.41–4.20) | <0.0001 | |
40–49 years | 8818 (15.8%) | 8604 (15.8%) | 214 (9.3%) | 2.4% | 4.74 (3.62–6.22) | <0.0001 | |
50–59 years | 7565 (13.3%) | 7201 (13.2%) | 364 (15.8%) | 4.8% | 9.41 (7.28–12.15) | <0.0001 | |
60–69 years | 4793 (8.4%) | 4330 (7.9%) | 463 (20.1%) | 9.7% | 18.89 (14.70–24.27) | <0.0001 | |
70–79 years | 2425 (4.3%) | 1915 (3.5%) | 510 (22.2%) | 21.0% | 41.12 (32.10–52.67) | <0.0001 | |
80+ years | 1419 (2.5%) | 933 (1.7%) | 486 (21.1%) | 34.2% | 66.96 (52.35–85.65) | <0.0001 | |
Pregnant (female population, ages 15 to 49; n = 17,693) | No | 16,638 (94.0%) | 16,457 (94.1%) | 181 (86.6%) | 1.1% | Reference | - |
Yes | 398 (2.2%) | 388 (2.2%) | 10 (4.8%) | 2.5% | 2.31 (1.23–4.33) | 0.0091 | |
Unknown | 657 (3.7%) | 639 (3.7%) | 18 (8.6%) | 2.7% | 2.52 (1.56–4.06) | 0.0002 | |
Angina | No | 55,915 (98.3%) | 53,850 (98.7%) | 2065 (89.9%) | 3.7% | Reference | <0.0001 |
Yes | 959 (1.7%) | 726 (1.3%) | 233 (10.1%) | 24.3% | 6.58 (5.84–7.41) | ||
Chronic heart disease 1 | No | 53,840 (94.7%) | 52,161 (95.6%) | 1679 (73.1%) | 3.1% | Reference | <0.0001 |
Yes | 3034 (5.3%) | 2415 (4.4%) | 619 (26.9%) | 20.4% | 6.54 (6.01–7.12) | ||
Heart failure | No | 56,003 (98.5%) | 53,975 (98.9%) | 2028 (88.3%) | 3.6% | Reference | <0.0001 |
Yes | 871 (1.5%) | 601 (1.1%) | 270 (11.7%) | 31.0% | 8.56 (7.68–8.54) | ||
Hypertension | No | 48,009 (84.4%) | 46,955 (86.0%) | 1054 (45.9%) | 2.2% | Reference | <0.0001 |
Yes | 8865 (15.6%) | 7621 (14.0%) | 1244 (54.1%) | 14.0% | 6.39 (5.91–6.92) | ||
Ischemic heart disease | No | 54,139 (95.2%) | 52,378 (96.0%) | 1761 (76.6%) | 3.3% | Reference | <0.0001 |
Yes | 2735 (4.8%) | 2198 (4.0%) | 537 (23.4%) | 19.6% | 6.04 (5.52–6.59) | ||
Myocardial infarct | No | 56,273 (98.9%) | 54,109 (99.1%) | 2164 (94.2%) | 3.8% | Reference | <0.0001 |
Yes | 601 (1.1%) | 467 (0.9%) | 134 (5.8%) | 22.3% | 5.80 (4.97–6.77) | ||
Immunosuppression 2 | No | 55,541 (97.7%) | 53,380 (97.8%) | 2161 (94.0%) | 3.9% | Reference | <0.0001 |
Yes | 1333 (2.3%) | 1196 (2.2%) | 137 (6.0%) | 10.3% | 2.64 (2.24–3.11) | ||
Rheumatoid arthritis | No | 56,198 (98.8%) | 53,998 (98.9%) | 2200 (95.7%) | 3.9% | Reference | <0.0001 |
Yes | 676 (1.2%) | 578 (1.1%) | 98 (4.3%) | 14.5% | 3.70 (3.07–4.47) | ||
Depression | No | 44,541 (78.3%) | 43,124 (79.0%) | 1417 (61.7%) | 3.2% | Reference | <0.0001 |
Yes | 12,333 (21.7%) | 11,452 (21.0%) | 881 (38.3%) | 7.1% | 2.25 (2.07–2.44) | ||
Intellectual and developmental disability 3 | No | 56,444 (99.2%) | 54,177 (99.3%) | 2267 (98.7%) | 4.0% | Reference | 0.0008 |
Yes | 430 (0.8%) | 399 (0.7%) | 31 (1.3%) | 7.2% | 1.79 (1.28–2.53) | ||
Mood and anxiety disorders | No | 41,590 (73.1%) | 40,322 (73.9%) | 1268 (55.2%) | 3.0% | Reference | <0.0001 |
Yes | 15,284 (26.9%) | 14,254 (26.1%) | 1030 (44.8%) | 6.7% | 2.21 (2.04–2.39) | ||
Schizophrenia and psychotic disorders | No | 56,112 (98.7%) | 53,927 (98.8%) | 2185 (95.1%) | 3.9% | Reference | <0.0001 |
Yes | 762 (1.3%) | 649 (1.2%) | 113 (4.9%) | 14.8% | 3.81 (3.20–4.53) | ||
Diabetes | No | 51,487 (90.5%) | 50,011 (91.6%) | 1476 (64.2%) | 2.9% | Reference | - |
Non-insulin | 5141 (9.1%) | 4541 (8.3%) | 600 (26.1%) | 11.7% | 4.07 (3.72–4.46) | <0.0001 | |
Insulin 5 | 246 (0.4%) | 24 (0.0%) | 222 (9.7) | 90.2% | 31.48 (29.50–33.59) | <0.0001 | |
Gout | No | 55,707 (97.9%) | 53,622 (98.3%) | 2085 (90.7%) | 3.7% | Reference | <0.0001 |
Yes | 1167 (2.1%) | 964 (1.7%) | 213 (9.3%) | 18.3% | 4.88 (4.29–5.55) | ||
Chronic kidney disease 4 | No | 54,686 (96.2%) | 52,928 (97.0%) | 1758 (76.5%) | 3.2% | Reference | <0.0001 |
Yes | 2188 (3.8%) | 1648 (3.0%) | 540 (23.5%) | 24.7% | 7.68 (7.04–8.37) | ||
Osteoarthritis | No | 52,645 (92.6%) | 50,975 (93.4%) | 1670 (72.7%) | 3.2% | Reference | <0.0001 |
Yes | 4229 (7.4%) | 3601 (6.6%) | 628 (27.3%) | 14.8% | 4.68 (4.29–5.10) | ||
Osteoporosis | No | 55,831 (98.2%) | 53,771 (98.5%) | 2060 (89.6%) | 3.7% | Reference | <0.0001 |
Yes | 1043 (1.8%) | 805 (1.5%) | 238 (10.4%) | 22.8% | 6.18 (5.49–6.97) | ||
Alzheimer/dementia | No | 56,624 (99.6%) | 54,411 (99.7%) | 2213 (93.3%) | 3.9% | Reference | <0.0001 |
Yes | 250 (0.4%) | 165 (0.3%) | 85 (3.7%) | 34.0% | 8.70 (7.28–10.39) | ||
Epilepsy | No | 56,465 (99.3%) | 54,216 (99.3%) | 2249 (97.9%) | 4.0% | Reference | <0.0001 |
Yes | 409 (0.7%) | 360 (0.7%) | 49 (2.1%) | 12.0% | 3.01 (2.31–3.92) | ||
Parkinsonism | No | 56,806 (99.9%) | 54,534 (99.9%) | 2272 (98.9%) | 4.0% | Reference | <0.0001 |
Yes | 68 (0.1%) | 42 (0.1%) | 26 (1.1%) | 38.2% | 9.56 (7.05–12.97) | ||
Stroke (combined) 5 | No | 56,571 (99.5%) | 54,351 (99.6%) | 2220 (96.6%) | 3.9% | Reference | <0.0001 |
Yes | 303 (0.5%) | 225 (0.4%) | 78 (3.4%) | 25.7% | 6.56 (5.39–7.98) | ||
Stroke (hemorrhagic) | No | 56,817 (99.9%) | 54,528 (99.9%) | 2289 (99.6%) | 4.0% | Reference | <0.0001 |
Yes | 57 (0.1%) | 48 (0.1%) | 9 (0.4%) | 15.8% | 3.92 (2.15–7.15) | ||
Stroke (ischemic) | No | 56,705 (99.7%) | 54,453(99.8%) | 2252 (98.0%) | 4.0% | Reference | <0.0001 |
Yes | 169 (0.3%) | 123 (0.2%) | 46 (2.0%) | 27.2% | 6.85 (5.34–8.80) | ||
Transitory ischemic attack | No | 56,773 (99.8%) | 54,504 (99.9%) | 2269 (98.7%) | 4.0% | Reference | <0.0001 |
Yes | 101 (0.2%) | 72 (0.1%) | 29 (1.3%) | 28.7% | 7.18 (5.27–9.79) | ||
Asthma | No | 49,270 (86.6%) | 47,435 (86.9%) | 1835 (79.9%) | 3.7% | Reference | <0.0001 |
Yes | 7604 (13.4%) | 7141 (13.1%) | 463 (20.1%) | 6.1% | 1.63 (1.48–1.81) | ||
Chronic obstructive pulmonary disease | No | 55,800 (98.1%) | 53,767 (98.5%) | 2033 (88.5%) | 3.6% | Reference | <0.0001 |
Yes | 1074 (1.9%) | 809 (1.5%) | 265 (11.5%) | 24.7% | 6.77 (6.05–7.58) | ||
Injection drug use 6 | No | 54,574 (96.0%) | 52,506 (96.2%) | 2068 (90.0%) | 3.8% | Reference | <0.0001 |
Yes | 2300 (4.0%) | 2070 (3.8%) | 230 (10.0%) | 10.0% | 2.64 (2.32–3.00) | ||
Problematic alcohol use 7 | No | 54,322 (95.5%) | 52,336 (95.9%) | 1986 (86.4%) | 3.7% | Reference | <0.0001 |
Yes | 2552 (4.5%) | 2240 (4.1%) | 312 (13.6%) | 12.2% | 3.34 (2.99–3.74) | ||
Cancer 8 | No | 50,865 (89.4%) | 49,182 (90.1%) | 1683 (73.2%) | 3.3% | Reference | <0.0001 |
Yes | 6009 (10.6%) | 5394 (9.9%) | 615 (26.8%) | 10.2% | 3.09 (2.83–3.38) | ||
Cirrhosis 7 | No | 56,635 (99.6%) | 54,402 (99.7%) | 2233 (97.2%) | 3.9% | Reference | <0.0001 |
Yes | 239 (0.4%) | 174 (0.3%) | 65 (2.8%) | 27.2% | 6.90 (5.58–8.52) |
Variable | Category | 26 January 2020–15 January 2021 (n = 56,874; Hospitalized = 2298) | |
---|---|---|---|
aRR (95% CI) * | p† | ||
Sex (vs. female) | Male | 1.27 (1.17–1.37) | <0.0001 |
Age ‡ (Reference group: 20–29 years) | <20 years | 0.51 (0.30–0.85) | 0.0103 |
30–39 years | 3.06 (2.32–4.03) | <0.0001 | |
40–49 years | 4.45 (3.40–5.82) | <0.0001 | |
50–59 years | 8.05 (6.22–10.41) | <0.0001 | |
60–69 years | 14.98 (11.58–19.37) | <0.0001 | |
70–79 years | 28.15 (21.64–36.61) | <0.0001 | |
80+ years | 43.68 (33.41–57.10) | <0.0001 | |
Asthma | 1.15 (1.04–1.26) | 0.0049 | |
Cancer 1 | 1.19 (1.09–1.29) | 0.0001 | |
Chronic kidney disease 2 | 1.32 (1.19–1.47) | <0.0001 | |
Diabetes (vs. non-diabetic) | Non-insulin | 1.13 (1.03–1.25) | 0.0112 |
Insulin 3 | 5.05 (4.43–5.76) | <0.0001 | |
Hypertension | 1.19 (1.08–1.31) | 0.0007 | |
Immunosuppression 4 | 1.30 (1.10–1.54) | 0.0019 | |
Injection drug use 5 | 2.51 (2.14–2.95) | <0.0001 | |
Intellectual and developmental disability 6 | 1.67 (1.05–2.66) | 0.0307 | |
Problematic alcohol use 7 | 1.63 (1.43–1.85) | <0.0001 | |
Schizophrenia and psychotic disorders | 1.49 (1.23–1.82) | <0.0001 |
Variable | Category | 26 January 2020–15 January 2021 (n = 17,036; Hospitalized = 191) | |
---|---|---|---|
aRR (95% CI) * | p† | ||
Age ** (Reference group: 20–29 years) | <20 years | 0.24 (0.06–0.95) | 0.0424 |
30–39 years | 1.99 (1.35–2.94) | 0.0005 | |
40–49 years | 2.32 (1.54–3.48) | <0.0001 | |
Asthma | 1.80 (1.29–2.52) | 0.0005 | |
Diabetes (vs. non-diabetic) | Non-insulin | 2.39 (1.46–3.89) | 0.0005 |
Insulin 1 | 31.89 (16.78–60.60) | <0.0001 | |
Hypertension | 2.02 (1.29–3.16) | 0.0020 | |
Injection drug use 2 | 3.97 (2.44–6.43) | <0.0001 | |
Pregnancy | 2.69 (1.42–5.07) | 0.0023 | |
Problematic alcohol use 3 | 3.05 (1.86–5.02) | <0.0001 |
Variable | Age Group | ||||||||
---|---|---|---|---|---|---|---|---|---|
All Age Groups ⁰ (n = 56,874; Hospitalized = 2298) | <40 Years (n = 31,854; Hospitalized = 261) | 40–59 Years (n = 16,383; Hospitalized = 578) | 60+ Years (n = 8637; Hospitalized = 1459) | ||||||
aRR (95% CI) * | p † | aRR (95% CI) * | p† | aRR (95% CI) * | p† | aRR (95% CI) * | p† | ||
Sex (male vs. female) | 1.27 (1.17–1.37) | <0.0001 | 0.99 (0.77–1.27) | 0.93 | 1.46 (1.24–1.72) | <0.0001 | 1.26 (1.15–1.38) | <0.0001 | |
Asthma | 1.15 (1.04–1.26) | 0.0049 | 1.10 (0.78–1.54) | 0.59 | 1.41 (1.16–1.71) | 0.0005 | 1.10 (0.98–1.23) | 0.09 | |
Cancer 1 | 1.19 (1.09–1.29) | 0.0001 | 1.47 (0.99–2.17) | 0.054 | 1.24 (1.00–1.54) | 0.0459 | 1.31 (1.19–1.44) | <0.0001 | |
Chronic kidney disease 2 | 1.32 (1.19–1.47) | <0.0001 | 2.68 (1.22–5.90) | 0.0141 | 1.32 (0.97–1.80) | 0.08 | 1.70 (1.53–1.88) | <0.0001 | |
Diabetes (vs. non-diabetic) | Non-insulin | 1.13 (1.03–1.25) | 0.0112 | 2.03 (0.98–4.17) | 0.055 | 1.62 (1.31–1.99) | <0.0001 | 1.01 (0.91–1.12) | 0.87 |
Insulin 3 | 5.05 (4.43–5.76) | <0.0001 | 20.29 (4.69–87.90) | <0.0001 | 19.30 (14.66–25.40) | <0.0001 | 3.94 (3.52–4.41) | <0.0001 | |
Hypertension | 1.19 (1.08–1.31) | 0.0007 | 1.87 (0.98–3.57) | 0.057 | 1.46 (1.21–1.75) | <0.0001 | 1.31 (1.18–1.46) | <0.0001 | |
Immunosuppression 4 | 1.30 (1.10–1.54) | 0.0019 | 2.56 (1.67–3.94) | <0.0001 | 1.30 (0.95–1.76) | 0.10 | 1.14 (0.93–1.38) | 0. 21 | |
Injection drug use 5 | 2.51 (2.14–2.95) | <0.0001 | 2.95 (1.78–4.90) | <0.0001 | 2.55 (1.97–3.30) | <0.0001 | 1.01 (0.76–1.32) | 0.97 | |
Intellectual and developmental disability 6 | 1.67 (1.05–2.66) | 0.0307 | 1.17 (0.56–2.42) | 0.68 | 4.28 (2.29–8.01) | <0.0001 | 1.21 (0.71–2.04) | 0.49 | |
Problematic alcohol use 7 | 1.63 (1.43–1.85) | <0.0001 | 2.84 (1.72–4.72) | <0.0001 | 1.62 (1.26–2.10) | 0.0002 | 1.53 (1.30–1.79) | <0.0001 | |
Schizophrenia and psychotic disorders | 1.49 (1.23–1.82) | <0.0001 | 2.33 (1.40–3.87) | 0.0012 | 1.19 (0.80–1.76) | 0.38 | 1.56 (1.21–2.00) | 0.0005 |
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Velásquez García, H.A.; Wilton, J.; Smolina, K.; Chong, M.; Rasali, D.; Otterstatter, M.; Rose, C.; Prystajecky, N.; David, S.; Galanis, E.; et al. Mental Health and Substance Use Associated with Hospitalization among People with COVID-19: A Population-Based Cohort Study. Viruses 2021, 13, 2196. https://doi.org/10.3390/v13112196
Velásquez García HA, Wilton J, Smolina K, Chong M, Rasali D, Otterstatter M, Rose C, Prystajecky N, David S, Galanis E, et al. Mental Health and Substance Use Associated with Hospitalization among People with COVID-19: A Population-Based Cohort Study. Viruses. 2021; 13(11):2196. https://doi.org/10.3390/v13112196
Chicago/Turabian StyleVelásquez García, Héctor Alexander, James Wilton, Kate Smolina, Mei Chong, Drona Rasali, Michael Otterstatter, Caren Rose, Natalie Prystajecky, Samara David, Eleni Galanis, and et al. 2021. "Mental Health and Substance Use Associated with Hospitalization among People with COVID-19: A Population-Based Cohort Study" Viruses 13, no. 11: 2196. https://doi.org/10.3390/v13112196