Mental health and substance use associated with hospitalization among people with COVID-19: A population-based cohort study

Abstract

This study identified factors associated with hospital admission among people with la-boratory-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 vis-its, 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 ro-bust 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 alco-hol 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 hospital-ization.