Objective
This study aimed to investigate the clinical outcomes and mortality risk factors associated with alcohol use disorder (AUD) in hospitalized COVID-19 patients.

Methods
We analyzed a national database containing information on the clinical and sociodemographic aspects of patients hospitalized with severe acute respiratory syndrome between February 2020 and February 2023 in Brazil, including those aged > 18 years with laboratory-confirmed COVID-19. The primary exposure of interest was a history of AUD before admission and the primary outcome was in-hospital mortality.

Results
Among the 2,124,285 patients, 11,433 (0.53 %) had AUD. The in-hospital mortality rate was higher in the patients with AUD (46.2%) than in those without AUD (31.9%). After adjusting for confounding covariates, individuals with AUD had twice the risk of death (Odds Ratio [OR]= 1.94, 95% confidence interval [CI] 1.85-2.03) compared with non-AUD patients. Among individuals with AUD, the covariates independently associated with the primary outcome were age > 60 years, male sex, hospitalization in the Central-West, Northeast and North regions, symptoms of dyspnea and reduced oxygen saturation at admission, presence of comorbidities, and year of admission.

Conclusion
In this population-based study, we found that patients with AUD had twice the risk of fatal outcomes than those without AUD.