BACKGROUND AND AIMS: Alcohol use disorders (AUD) have not been included in the priority groups for early vaccine against SARS-CoV-2. We aimed to determine adverse outcomes after SARS-CoV-2 infection among individuals with AUD and how this is modified by vaccination.

DESIGN: Registry-based cohort study.

SETTING: Denmark, 27 February 2020 until 15 October 2021.

PARTICIPANTS: 2157 individuals with AUD and 237,541 without AUD who had a polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection during the study period.

MEASUREMENTS: The association of AUD with the absolute and relative risk of hospitalisation, intensive care and 60-day mortality after SARS-CoV-2 infection and of all-cause mortality throughout the follow-up period. Potential interactions with SARS-CoV-2 vaccination, education and sex were explored in stratified analysis and tested by including interaction terms and using likelihood ratio tests.

FINDINGS: Individuals with AUD had an increased absolute and relative risk of adverse outcomes including hospitalisation [incidence rate ratio (IRR), 1.72 (95% confidence interval [CI]: 1.51-1.95)], intensive care [IRR, 1.47 (95%CI: 1.07-2.02)] and 60-day mortality [mortality rate ratio (MRR), 2.35 (95%CI: 1.94-2.85)] compared with SARS-CoV-2 positive individuals without AUD. Irrespective of AUD, highest risks of these adverse health outcomes were observed for individuals not vaccinated against SARS-CoV-2 infection, for individuals of low educational level and in males. However, for all-cause mortality throughout the follow-up period, SARS-CoV-2 infection gave a lower relative mortality risk increase, whereas being unvaccinated gave a higher relative mortality risk increase, in individuals with AUD than in the reference population without AUD (p of interaction tests < 0.0001).

CONCLUSIONS: Both alcohol use disorder and being unvaccinated for SARS-CoV-2 appear to be independent risk factors for adverse health outcomes following SARS-CoV-2 infection.