The investigation used real-world clinical data from more than 460,000 U.S. veterans with documented SARS-CoV-2 infection, which were obtained from the VA Corporate Data Warehouse. The participants were monitored between March 1, 2020, and April 30, 2022. The researchers determined that AUD on its own aggravates COVID-19 outcomes, and that this is further compounded when combined with high-risk alcohol use.
To investigate the impact of AUD and alcohol consumption on severity of COVID-19, researchers employed retrospective information for 463,246 veterans who had tested positive for COVID-19 and had self-reported alcohol use records through the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C).
Participants were divided into:
No AUD (n = 429,803; median age: 61 years)
Alcohol abuse (n = 10,191; 2.2%; median age: 54 years)
Alcohol dependence (n = 17,803; 3.8%; median age: 54 years)
Alcohol-related disease (ARD) (n = 5,449; 1.2%; median age: 62 years)
COVID-19 severity was defined as:
The study evaluated outcomes across alcohol consumption and AUD severity levels using adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) to measure associations.
Key Findings
Total participants: 463,246 veterans with COVID-19 and AUDIT-C scores
AUD prevalence: 7.2% (n = 33,443)
Alcohol abuse: 2.2% (n = 10,191)
Alcohol dependence: 3.8% (n = 17,803)
ARD: 1.2% (n = 5,449)
Mortality (30 days): 3.6% overall; 5.9% in ARD with high consumption
Risk of hospitalization highest in ARD + high alcohol group:
Hospitalization without critical care: aRR 2.50
Critical care: aRR 2.01
Death: aRR 1.91
These quantitative findings endorse a clear, graded association between alcohol misuse and COVID-19 severity.
This large-scale investigation presents strong evidence that alcohol use disorder, particularly in conjunction with high-risk drinking, is linked to more severe COVID-19 outcomes, including increased hospitalization rates, critical illness, and mortality. These results emphasize the pressing need for incorporating alcohol use screening and intervention into larger public health plans, particularly pandemic response planning.
Reference:
Turner, A. P., Adams, S. V., Hawkins, E., Fan, V. S., Nikzad, R., Kundzins, J. R., & Crothers, K. (2025). Alcohol use and COVID-19 outcomes. Chest. https://doi.org/10.1016/j.chest.2025.05.039
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