Disparities by sex in COVID-19 risk and related harms among people with opioid use disorder (conference)

Abstract

Aim: Recent evidence indicates increased risks of COVID-19 morbidity and mortality among individuals with substance use disorder, with a possible female disadvantage for opioid use disorder (OUD) contrary to males in the general population. COVID-19 outcomes have yet to be assessed using sex-stratified data to identify differential impacts between males and females. Study aims were to: (1) Report sex-specific COVID-19 outcomes, opioid overdose, and mortality among individuals with OUD at a public safety net health system; (2) Assess sex-specific factors associated with 60-day all-cause, in-hospital mortality within a socioecological framework.
Methods: All patients receiving a SARS-CoV-2 test in year 2020 with OUD (ICD-10 and/or buprenorphine/ naltrexone prescription) were included. Bioinformatic search criteria abstracted outcomes from the medical record from January 1, 2020, through 60 days after the SARS-CoV-2 test. Analysis was performed in SAS. Chi-squared and Student t-tests assessed differences by sex. Multivariable regression was used for Aim 2, with results pending at this time.
Results: Data was abstracted for 2,600 patients with OUD (1,294 males; 1,306 females). A third were over 60 years, and the majority were Black (52%) with public insurance (Medicaid 28%, Medicare 31%). Most were overweight (male mean BMI 28) or obese (female mean BMI 31; p<0.001). Approximately half were smoking cigarettes (male 52%, female 40%; p<0.001). Across sex, 5% had a positive SARS-CoV-2 test (p=0.42) with similar incidences of hospitalization, ICU admission, and mechanical ventilator use. More males (10%) presented with an overdose than females (4%; p<0.001) and died as a result (males n=5; females n=0). However, 60-day all-cause, in-hospital mortality did not differ by sex (males 5%, females 4%; p=0.42). 
Conclusions: Sex is an important biological variable that modifies health, including OUD and COVID-19. Within a majority Black population, COVID-19 outcomes were similar across sex, but males and females with OUD may differ in predisposing factors.

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https://discovery.dundee.ac.uk/en/publications/488b0f2b-b418-481a-829c-e756bbe609f8