COVID-19, heavy drinking and alcohol use disorders: a national study of Veterans Administration patients

COVID-19、酗酒和酒精使用障碍：一项针对退伍军人管理局患者的全国研究

• 批准号: 10596115
• 负责人: DEBORAH S HASIN
• 金额: $ 18.72万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10596115
• 关键词: 2019-nCoV; Acute Respiratory Distress Syndrome; Address; Affect; Age; Alcohol consumption; Alcohols; Back; Behavioral; Big Data; Biological; Black Populations; Black race; COVID-19; COVID-19 prognosis; COVID-19 risk; COVID-19 severity; COVID-19 susceptibility; COVID-19 vaccination; Caring; Cause of Death; Cessation of life; Characteristics; Chronic; Computerized Medical Record; County; Data; Databases; Diabetes Mellitus; Diagnosis; Diagnostic; Disasters; Disease; Ethnic Origin; Event; Exploratory/Developmental Grant; Funding; Future; General Population; Health; Health behavior; Heavy Drinking; Hispanic; Hispanic Populations; Hospitalization; Hypertension; ICD-10-CM; Immune response; Immune system; Impairment; Individual; Infection; Intensive Care; Knowledge; Link; Logistic Regressions; Medical; Medicare; Minority; Misinformation; Modeling; National Institute on Alcohol Abuse and Alcoholism; Obesity; Outcome; Patients; Persons; Pneumonia; Policies; Poverty; Prevalence; Preventive; Process; Prognosis; Provider; Race; Research Infrastructure; Retrospective cohort; Risk; SARS-CoV-2 exposure; SARS-CoV-2 infection; SARS-CoV-2 negative; Scientist; Services; Social Environment; Statistical Data Interpretation; Stress; Testing; Time; United States Department of Veterans Affairs; Vaccinated; Vaccination; Vaccines; Veterans; Virus Diseases; Vital Status; alcohol effect; alcohol screening; alcohol use disorder; coping; cost; data repository; data resource; data sharing; data sharing networks; demographics; design; drinking; electronic medical record system; housing instability; human old age (65+); indexing; infection risk; interest; male; men; mortality; novel coronavirus; pandemic disease; residence; service providers; sex; sociodemographics; vaccine distribution; vaccine hesitancy

Coronavirus Disease 2019 (COVID-19) caused by SARS-CoV-2 is a global pandemic. While most COVID-19 cases are mild or moderate, severe cases (~15%) require hospitalization, critical cases (~5%) require intensive care, and many deaths occur. Males, Blacks and Hispanics are at greater risk for COVID-19 infection, and poor prognosis is predicted by older age, race/ethnicity, and prior underlying medical conditions. A potentially critical factor not yet studied is heavy alcohol use or alcohol use disorder (AU/AUD). AU/AUD could increase the risk for COVID-19 infection and poor prognosis through poor health behaviors, by direct effects of alcohol on the immune system, or by indirect effects due to the greater prevalence of underlying medical conditions that predict poor COVID-19 prognosis. Little is known about the relationship of AU/AUD to the likelihood of COVID-19 vaccination, infection, or poor prognosis, and if these relationships are modified by medical conditions (e.g., hypertension, obesity, diabetes), spatially-defined socioenvironmental or exposure variables (e.g., county poverty or COVID-19 rates) or demographic characteristics (sex, age, race/ethnicity, poverty). To study this, large databases are needed that include AU/AUD, demographic characteristics, spatial identifiers, diagnostic, treatment and mortality information. Responding to PA-20-195 (and addressing issues in NOT-AA-20-011), we will utilize the Veterans Administration (VA) Electronic Medical Record (EMR) system for this purpose. The VA treats 6.3 million veterans a year. VA patients have high rates of COVID-19 vulnerability factors, e.g., male, older age, chronic medical conditions. A VA Shared Data Resource identifies COVID-19 cases (now N=186,174, with 9,299 deaths). The many VA patients with ICD-10-CM AUD or positive alcohol (AUDIT-C) screens provide extensive data on whether the likelihood of COVID-19 outcomes differ by AU/AUD status. Leveraging a research infrastructure established in an existing project, we propose a 2-year study to comprehensively address the relationship of AU/AUD to COVID-19 vaccination, infection and prognosis, and how these relationships are affected by demographic, medical, spatial exposure characteristics. Aim1: Determine the relationship of AU/AUD to COVID-19 vaccination, infection, and in those infected, poor prognosis (e.g., hospitalization, ICU treatment, death). Aim 2: Determine if associations of AU/AUD with COVID-19 outcomes vary over time, medical conditions (e.g., hypertension, obesity, diabetes), spatial exposures or demographic characteristics. In Year 01, we will analyze EMR diagnostic, treatment, and vital status death data, using a 12-month lookback period to determine AU/AUD and medical conditions that preceded COVID-19 outcome variables. In Year 02, we will incorporate National Death Index data to examine causes of death, and expand information on veterans ≥age 65 with Medicare data. Logistic regression will evaluate differences in COVID-19 outcomes by AU/AUD status. Among those with COVID-19, survival models will determine if time to poor prognosis events differs by AU/AUD. Results will fill major gaps in knowledge about the risks for and prognosis of COVID-19 among those with AU/AUD.

SARS-COV-2引起的冠状病毒疾病2019年（Covid-19）是全球大流行。而大多数covid-19 病例是轻度或中等，严重病例（约15％）需要住院，关键病例（约5％）需要密集 护理，发生许多死亡。男性，黑人和西班牙裔人患相互vid-19感染的风险更大，而且很差 预后由年龄，种族/种族和先前的基本医疗状况预测。潜在的关键 尚未研究的因素是大量饮酒或酒精使用障碍（AU/AUD）。 AU/AUD可能会增加风险 通过不良的健康行为，通过酒精对健康行为不良的感染和预后不良，直接影响酒精对 免疫系统或由于预测潜在的医疗状况的较高流行率而受到间接影响 covid-19-19的预后不良。关于AU/AUD与Covid-19的可能性的关系知之甚少 疫苗接种，感染或预后不良，如果这些关系是通过医疗状况改变的（例如， 高血压，肥胖，糖尿病），空间定义的社会环境或暴露变量（例如，县 贫困或共同率-19率）或人口特征（性别，年龄，种族/种族，贫困）。为了研究这一点， 需要大型数据库，其中包括AU/AUD，人口统计学特征，空间标识符，诊断， 治疗和死亡率信息。在回应PA-20-195（以及在Not-AA-20-011中解决问题）时，我们 将出于这个目的，将利用退伍军人管理（VA）电子病历（EMR）系统。 VA 每年对630万退伍军人进行待遇。 VA患者的共同漏洞因素较高，例如男性，年龄较大 年龄，慢性医疗状况。 VA共享数据资源标识了Covid-19情况（现在n = 186,174， 9,299人死亡）。 ICD-10-CM AUD或阳性酒精（审核-C）筛查的许多VA患者提供 关于Covid-19结果的可能性是否与AU/AUD状态不同的广泛数据。利用研究 在现有项目中建立的基础设施，我们提出了一项为期两年的研究，以全面解决 AU/AUD与COVID-19疫苗接种，感染和预后以及这些关系的关系 受人口统计学，医学，空间暴露特征的影响。 AIM1：确定AU/AUD的关系 与19次疫苗接种，感染和感染者预后不良（例如，住院，ICU治疗， 死亡）。目标2：确定AU/AUD与Covid-19结果的关联是否随着时间的流逝而变化 （例如，高血压，肥胖，糖尿病），空间暴露或人口统计学特征。在01年，我们将 使用12个月的回顾期分析EMR诊断，治疗和生命状态死亡数据 AU/AUD和医疗条件在COVID-19结果变量之前。在02年，我们将合并 国家死亡指数数据以检查死亡原因，并扩展有关退伍军人≥65的信息 Medicare数据。逻辑回归将通过AU/AUD状态评估Covid-19结果的差异。之中 那些患有COVID-19的人，生存模型将确定预后事件不良的时间是否有AU/AUD的不同。结果 在知道AU/AUD的人群中，Covid-19的风险和预后将填补主要空白。