# Cannabis use associated with lower mortality among hospitalized Covid-19 patients using the national inpatient sample: an epidemiological study

## TL;DR

Hospitalized patients who used cannabis had lower odds of dying from or experiencing severe complications from Covid-19 compared to non-users.

## Contribution

This study is the first to show that cannabis use is associated with reduced mortality and complications in hospitalized Covid-19 patients.

## Key findings

- Cannabis users had 83.97% lower odds of death from Covid-19 compared to non-users.
- Cannabis use was linked to lower rates of mechanical ventilation and acute pulmonary embolism in hospitalized patients.
- Active cannabis users had significantly better outcomes than non-users in propensity score-matched analysis.

## Abstract

Prior reports indicate that modulation of the endocannabinoid system (ECS) may have a protective benefit for Covid-19 patients. However, associations between cannabis use (CU) or CU not in remission (active cannabis use (ACU)), and Covid-19-related outcomes among hospitalized patients is unknown.

In this multicenter retrospective observational cohort analysis of adults (≥ 18 years-old) identified from 2020 National Inpatient Sample database, we utilize multivariable regression analyses and propensity score matching analysis (PSM) to analyze trends and outcomes among Covid-19-related hospitalizations with CU and without CU (N-CU) for primary outcome of interest: Covid-19-related mortality; and secondary outcomes: Covid-19-related hospitalization, mechanical ventilation (MV), and acute pulmonary embolism (PE) compared to all-cause admissions; for CU vs N-CU; and for ACU vs N-ACU.

There were 1,698,560 Covid-19-related hospitalizations which were associated with higher mortality (13.44% vs 2.53%, p ≤ 0.001) and worse secondary outcomes generally. Among all-cause hospitalizations, 1.56% of CU and 6.29% of N-CU were hospitalized with Covid-19 (p ≤ 0.001). ACU was associated with lower odds of MV, PE, and death among the Covid-19 population. On PSM, ACU(N(unweighted) = 2,382) was associated with 83.97% lower odds of death compared to others(N(unweighted) = 282,085) (2.77% vs 3.95%, respectively; aOR:0.16, [0.10–0.25], p ≤ 0.001).

These findings suggest that the ECS may represent a viable target for modulation of Covid-19. Additional studies are needed to further explore these findings.

The online version contains supplementary material available at 10.1186/s42238-024-00228-w.

Question: Is cannabis use associated with adverse Covid-19-related outcomes among hospitalized patients?

Findings: History of cannabis use was associated with significantly lower odds of Covid-19-related hospitalization, mechanical ventilation, and death compared to those without history of cannabis use.

Meaning: Our study findings suggest that the endocannabinoid system may represent a viable target for modulation of moderate and severe Covid-19 disease (Covid-19). Additional prospective studies are needed to further explore these findings.

The online version contains supplementary material available at 10.1186/s42238-024-00228-w.