目标:在接受阿片类药物激动剂治疗(OAT)的人群中,由于潜在的健康问题和脆弱的社会环境,COVID-19感染和疾病的风险可能更高。我们的目的是确定最近的OAT,与过去的曝光相比,(i)SARS-CoV-2检测,(ii)SARS-CoV-2检测阳性和(iii)因COVID-19疾病住院/死亡的受影响风险。
方法:我们在2015年至2020年期间纳入了苏格兰OAT处方的个人。我们对SARS-CoV-2PCR检测进行了记录链接,疫苗接种,住院治疗,和死亡率数据,并从2020年3月至2021年12月跟进。我们使用比例风险分析和多变量逻辑回归来估计最近的OAT处方(前两个月)之间的关联,与过去的暴露(停止治疗超过一年)相比,和COVID-19结果。针对混杂因素对模型进行了调整。
结果:在36,093名服用OAT的人中,19,071人(52.9%)接受了SARS-CoV-2检测,2,896人(8.3%)检测呈阳性,552人(1.5%)因COVID-19住院/死亡。最近的OAT,与过去的曝光相比,与受测者中检测阳性的几率较低相关(AOR,0.63;95%CI,0.57,0.69)。然而,在那些测试呈阳性的人中,最近的OAT与住院/死亡几率高出两倍(aOR,2.04;95%CI,1.60,2.59)。
结论:我们发现最近的OAT与SARS-CoV-2感染的几率较低有关,但是一旦被诊断出疾病的几率更高。需要临床研究来阐明OAT在这些关联中的作用。有必要加大努力,增加OAT患者的疫苗覆盖率,以减轻COVID-19的严重后果。
OBJECTIVE: Among people receiving opioid-agonist treatment (OAT), the risk of COVID-19 infection and disease may be higher owing to underlying health problems and vulnerable social circumstances. We aimed to determine whether recent OAT, when compared with past exposure, affected the risk of (i) testing for SARS-CoV-2, (ii) testing positive for SARS-CoV-2, and (iii) being hospitalized or dying with COVID-19 disease.
METHODS: We included individuals prescribed OAT in Scotland from 2015 to 2020. We performed record linkage to SARS-CoV-2 PCR testing, vaccination, hospitalization, and mortality data, and followed up from March 2020 to December 2021. We used proportional hazards analysis and multivariate logistic regression to estimate associations between recent OAT prescription (in the previous 2 months), compared with past exposure (off treatment for over a year), and COVID-19 outcomes. Models were adjusted for confounders.
RESULTS: Among 36 093 individuals prescribed OAT, 19 071 (52.9%) were tested for SARS-CoV-2; 2896 (8.3%) tested positive; and 552 (1.5%) were hospitalized or died with COVID-19. Recent OAT, compared with past exposure, was associated with lower odds of testing positive among those tested (aOR, 0.63; 95% CI, 0.57-0.69). However, among those testing positive, recent OAT was associated with two-fold higher odds of hospitalization or death (aOR, 2.04; 95% CI, 1.60-2.59).
CONCLUSIONS: We found that recent OAT was associated with lower odds of SARS-CoV-2 infection, but with higher odds of disease once diagnosed. Clinical studies are needed to unravel the role of OAT in these associations. An enhanced effort is warranted to increase vaccine coverage among OAT patients to mitigate the severe consequences of COVID-19.