Opioid Use Associated With Worse Outcomes in Those Hospitalized With Influenza

Among those hospitalized for influenza who use drugs, opioid use is significantly associated with an increased risk for mechanical ventilation and admission to the intensive care unit (ICU), according to study findings published in Influenza and Other Respiratory Viruses.

Investigators explored the relationship between drug use and severe influenza-associated outcomes. The investigators examined individuals hospitalized with influenza who both did and did not use drugs to identify between-group differences in their demographic, clinical, and behavioral characteristics, as well as their outcomes of care.

The researchers conducted a population-based review and analysis of data collected by the Influenza Hospitalization Surveillance Network (FluSurv-NET) that included 48,430 adults in the US hospitalized during the 2016-2017, 2017-2018, and 2018-2019 influenza seasons. People who used drugs (PWUD) were defined as those with documented drug use within the year prior to admission. The researchers analyzed outcomes related to various drug types (depressants, stimulants, opioids, hallucinogens, inhalants) and defined alcohol abuse and tobacco use as behavioral influences. E-cigarettes and marijuana use were excluded from the current analysis.

Investigators identified 2019 people in the database who used drugs and were hospitalized with influenza during the study period. Compared with those who did not use drugs, the PWUD were younger (median age 53.0 vs 69.0 years) and more likely to be male (59.4% vs 44.2%), non-Hispanic Black (40.8% vs 17.9%) or Hispanic/Latino (8.9% vs 7.0%). People using drugs vs those who did not use drugs were more likely to have chronic conditions (lung disease, 36.0% vs 29.9%, respectively; liver disease, 31.8% vs 5.4%, respectively; and asthma, 26.8% vs 20.0%, respectively) or immunosuppressive conditions. PWUD had a greater tendency to smoke tobacco (current use, 69.3% vs 17.8%, respectively) and abuse alcohol (current use, 21.8% vs 2.7%, respectively), than those who did not use drugs.

Likewise, people hospitalized for influenza who used drugs were less likely to have received a seasonal influenza vaccine in the corresponding year than those who did not use drugs (36.3% vs 59%, respectively).

The PWUD, compared with those who did not use drugs, had greater odds of mechanical ventilation (9.2% vs 5.3%, respectively) and ICU admission (20.9% vs 14.9%, respectively) but not death (2.5% vs 3.0%, respectively). However, these findings had no statistical significance after adjustment. Only opioid use was statistically associated with increased mechanical ventilation and ICU admission risk.

Review and analysis limitations include the lack of data on some relevant variables; incomplete or incorrect information in medical records; response bias in self-reported data; a major discrepancy between the percentage of PWUD in the study vs in the National Center for Health Statistics data (about 4% vs 11.7%, respectively); and the non-generalizability of study results to the entire population.

Investigators concluded adults hospitalized in the US with influenza who used drugs were significantly different than those who did not use drugs with respect to behavioral factors, comorbidities, demographics, and outcomes. “These results support targeted initiatives to prevent influenza in this population, including influenza vaccination, which remains one of the most important tools to prevent influenza infection and associated severe outcomes,” said study authors.

This article originally appeared on Pulmonology Advisor