key: cord-0757973-x3h4inyj
authors: Slaunwhite, Amanda Kathleen; Gan, Wen Qi; Xavier, Chloe; Zhao, Bin; A Buxton, Jane; Desai, Roshni
title: Overdose and Risk Factors for Severe Acute Respiratory Syndrome
date: 2020-05-08
journal: Drug Alcohol Depend
DOI: 10.1016/j.drugalcdep.2020.108047
sha: 3203f42a3fc0112d8e779a09d453b0747c98ef76
doc_id: 757973
cord_uid: x3h4inyj

Abstract Background There have been significant efforts to respond to the two public health emergencies of COVID-19 and overdose in British Columbia (BC) Canada. The purpose of this study was to quantify the prevalence of known risk factors associated with mortality due to severe acute respiratory syndrome coronavirus 2 (COVID-19) for persons who have had a non-fatal overdose (2015-2017) in comparison to persons who have not had an overdose. Methods Data were extracted from the BC Provincial Overdose Cohort (ODC) which includes a 20% random sample of BC residents and persons who have had a non-fatal overdose in BC from January 2015-December 2017. Chi-square tests and logistic regression were used to compare risk factors by overdose history. Results Persons who had an overdose were significantly more likely to have three (chronic pulmonary disease, diabetes, coronary heart disease) of the four known chronic conditions associated with the development of severe illness due to COVID-19 compared to persons who did not have a previous non-fatal overdose event. Conclusion Persons who had an overdose were more likely to have several chronic conditions associated with the development of severe illness due to COVID-19. The increased likelihood of having these risk factors is reflective of the social and health inequities experienced by persons who have a history of overdose.

Highlights  Efforts are underway to respond to the dual emergencies of COVID-19 and overdose.  Persons with a previous overdose were more likely to have many chronic conditions.  Findings reflect health inequities by persons who have a history of overdose.

Background: There have been significant efforts to respond to the two public health emergencies of COVID-19 and overdose in British Columbia (BC) Canada. The purpose of this study was to quantify the prevalence of known risk factors associated with mortality due to severe acute respiratory syndrome coronavirus 2 (COVID-19) for persons who have had a non-fatal overdose (2015) (2016) (2017) in comparison to persons who have not had an overdose.

Methods: Data were extracted from the BC Provincial Overdose Cohort (ODC) which includes a 20% random sample of BC residents and persons who have had a non-fatal overdose in BC from January 2015-December 2017. Chi-square tests and logistic regression were used to compare risk factors by overdose history.

J o u r n a l P r e -p r o o f Results: Persons who had an overdose were significantly more likely to have three (chronic pulmonary disease, diabetes, coronary heart disease) of the four known chronic conditions associated with the development of severe illness due to COVID-19 compared to persons who did not have a previous non-fatal overdose event.

Conclusion: Persons who had an overdose were more likely to have several chronic conditions associated with the development of severe illness due to COVID-19. The increased likelihood of having these risk factors is reflective of the social and health inequities experienced by persons who have a history of overdose.

Overdose, Substance Use, COVID-19, Risk Factors

There have been significant efforts to respond to the dual public health emergencies of COVID-19 and overdose in British Columbia (BC) Canada including the provision of pharmaceutical alternatives to the toxic drug supply. 1 The purpose of this analysis was to quantify the prevalence of known risk factors associated with mortality due to severe acute respiratory syndrome coronavirus 2 (COVID-19) for persons who have had a non-fatal overdose (2015) (2016) (2017) in comparison to persons who have not had an overdose.

Data were extracted from the Provincial Overdose Cohort (ODC), which includes a 20% random sample of BC residents and persons who have had a non-fatal overdose in BC from January 1 2015 to December 31, 2017. The ODC and definitions for identification of overdose cases are described elsewhere. 2 Persons who died prior to December 31, 2017 were excluded. Risk factors for serious COVID-19-related illness were identified from the literature: 1) chronic pulmonary disease (including asthma, COPD), 2) diabetes, 3) hypertension, 4) coronary heart disease, 5) over 50 years of age, 6) male sex, and 7) Elixhauser Comorbidity Index (ECI) of 2+. 3, 4 To be recorded as having risk factors 1-4, persons must have had two physician billing records or one hospitalization record in a one year period from 2015-2017. 5,6 Demographic information were extracted from the Client Roster for the year 2017. 7 The ECI was calculated using hospitalization data for all chronic diseases excluding respiratory illness, drug abuse, diabetes, hypertension, and coronary heart disease. Chi-square tests were used to compare risk factors by overdose history.

Logistic regression was used to calculate the odds ratio of having a risk factor for persons who had a previous overdose compared with persons who did not have an overdose after adjusting for age and sex. Statistical significance was defined as p <.05.

This study included 1,041,536 persons, 19,005 persons had one or more non-fatal overdose events from 2015-2017. The average age was 39 years and 50.0% were male. Among persons who had an overdose, 56.0% had a record of receiving social assistance (N=10,649) from 2015-2017. Of these persons, 53.7% had a record of no fixed address from 2015-2017 (N=5,716).

After adjusting for age and sex, persons who had a previous overdose were more likely to have J o u r n a l P r e -p r o o f chronic pulmonary disease, diabetes, coronary heart disease, and an ECI of over two compared with persons who did not have a previous overdose (Table 1) .

Persons who had an overdose were more likely to have three of the four known chronic conditions associated with the development of severe illness due to COVID-19. The increased likelihood of having these risk factors is reflective of the social and health inequities experienced by persons who have a history of overdose. Despite being a younger population, persons who have a history of overdose were more likely to have co-morbid physical conditions. Overdose events and chronic health conditions are likely underreported due to misclassification bias.

Increasing use of take home naloxone in community settings has reduced reliance on health care providers to reverse overdose which is believed to have lowered health care utilization for overdose events. The high proportion of persons who had a previous overdose who received income assistance and experienced homelessness may suggest limited access to material resources to support physical isolation.

Author Contributions: Dr. Wen Qi Gan and Dr. Amanda Slaunwhite had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors approved of the final article for publication. 

Risk-Mitigation-in-the-Context-of-Dual-Public-Health-Emergencies-v1.2.pdf

Development and Characteristics of the Provincial Overdose Cohort in British Columbia

Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study

Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the Coronavirus Disease 2019 (COVID-19) Pandemic

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Acknowledgements: All inferences, opinions, and conclusions drawn in this manuscript are those of the authors, and do not reflect the opinions or policies of the Data Steward(s).