Alcohol use disorder and risk of incident COVID-19 infection: A nested case-control study in Taiwan.

Abstract

Alcohol use disorder (AUD) may induce angiotensin-converting enzyme 2 (ACE2) overexpression, potentially increasing vulnerability to severe acute respiratory syndrome coronavirus-2 infection. However, the relationship between AUD and the risk of coronavirus disease 2019 (COVID-19) infection remains unclear. This study aimed to measure the association between AUD and the incidence of COVID-19 infection. We identified 247 000 individuals with AUD between 2001 and 2019 from the Taiwan National Health Insurance Research Database. Another 2 470 000 age- and sex-matched controls without AUD were randomly selected for comparison. All study participants were followed up until the occurrence of new-onset COVID-19 infection, death, or December 31, 2021. Taiwan National Health Insurance Research Database. A total of 247 000 individuals with AUD and 2 470 000 controls without AUD. A new diagnosis of COVID-19 was determined by a positive real-time reverse transcriptase-polymerase chain reaction test. We employed a Cox regression model, considering death as a competing risk, to assess the impact of AUD on the risk of COVID-19 infection. Among 2 717 000 participants, 2374 developed incident COVID-19 during an average follow-up of 1.98 years, including 415 (0.17%) individuals with AUD and 1959 (0.08%) controls. After adjusting for age, sex, urbanization, COVID-19 vaccination status, anxiety disorder, and the Charlson Comorbidity Index, AUD was statistically significantly associated with a higher risk of incident COVID-19 infection (adjusted hazard ratio [AHR]:1.19; 95% confidence interval [CI]:1.06-1.34). Subgroup analyses, stratified by age, sex, and COVID-19 vaccination status, revealed that AUD was linked to the risk of incident COVID-19 infection across all subgroups, except for individuals aged 18-49 years, men, and those who were unvaccinated. Alcohol use disorder appears to be an independent risk factor for incident COVID-19 infection. These findings highlight the importance of prioritizing individuals with AUD as a key target population for COVID-19 prevention efforts.