University of Illinois at Chicago

File(s) stored somewhere else

Please note: Linked content is NOT stored on University of Illinois at Chicago and we can't guarantee its availability, quality, security or accept any liability.

Investigating Unhealthy Alcohol Use As an Independent Risk Factor for Increased COVID-19 Disease Severity: Observational Cross-sectional Study

journal contribution
posted on 2022-11-11, 22:40 authored by Sameer Bhalla, Brihat Sharma, Dale Smith, Randy Boley, Connor McCluskey, Yousaf Ilyas, Majid Afshar, Robert Balk, Niranjan Karnik, Ali Keshavarzian
BACKGROUND: Unhealthy alcohol use (UAU) is known to disrupt pulmonary immune mechanisms and increase the risk of acute respiratory distress syndrome in patients with pneumonia; however, little is known about the effects of UAU on outcomes in patients with COVID-19 pneumonia. To our knowledge, this is the first observational cross-sectional study that aims to understand the effect of UAU on the severity of COVID-19. OBJECTIVE: We aim to determine if UAU is associated with more severe clinical presentation and worse health outcomes related to COVID-19 and if socioeconomic status, smoking, age, BMI, race/ethnicity, and pattern of alcohol use modify the risk. METHODS: In this observational cross-sectional study that took place between January 1, 2020, and December 31, 2020, we ran a digital machine learning classifier on the electronic health record of patients who tested positive for SARS-CoV-2 via nasopharyngeal swab or had two COVID-19 International Classification of Disease, 10th Revision (ICD-10) codes to identify patients with UAU. After controlling for age, sex, ethnicity, BMI, smoking status, insurance status, and presence of ICD-10 codes for cancer, cardiovascular disease, and diabetes, we then performed a multivariable regression to examine the relationship between UAU and COVID-19 severity as measured by hospital care level (ie, emergency department admission, emergency department admission with ventilator, or death). We used a predefined cutoff with optimal sensitivity and specificity on the digital classifier to compare disease severity in patients with and without UAU. Models were adjusted for age, sex, race/ethnicity, BMI, smoking status, and insurance status. RESULTS: Each incremental increase in the predicted probability from the digital alcohol classifier was associated with a greater odds risk for more severe COVID-19 disease (odds ratio 1.15, 95% CI 1.10-1.20). We found that patients in the unhealthy alcohol group had a greater odds risk to develop more severe disease (odds ratio 1.89, 95% CI 1.17-3.06), suggesting that UAU was associated with an 89% increase in the odds of being in a higher severity category. CONCLUSIONS: In patients infected with SARS-CoV-2, UAU is an independent risk factor associated with greater disease severity and/or death.


Great Lakes Node of the Drug Abuse Clinical Trials Network | Funder: National Institutes of Health (National Institute on Drug Abuse) | Grant ID: UG1DA049467



Bhalla, S., Sharma, B., Smith, D., Boley, R., McCluskey, C., Ilyas, Y., Afshar, M., Balk, R., Karnik, N.Keshavarzian, A. (2021). Investigating Unhealthy Alcohol Use As an Independent Risk Factor for Increased COVID-19 Disease Severity: Observational Cross-sectional Study. JMIR Public Health and Surveillance, 7(11), e33022-.


JMIR Publications Inc.


  • en