Substance Use Disorder Diagnoses Among Older Medicare Beneficiaries Hospitalized With Traumatic Brain Injury

TL;DR

This study finds that about 8% of older adults hospitalized with traumatic brain injury have pre-existing alcohol or substance use disorders, with notable associations to age, gender, and coexisting health conditions.

Contribution

The study provides new insights into the prevalence and characteristics of substance use disorders among older adults with traumatic brain injury using Medicare data.

Findings

Prevalence of pre-existing AUD/SUD among older TBI patients was 8.4%, with AUD being more common than SUD.

Opioid use disorder was the most common SUD diagnosis among those with SUD.

Patients with AUD/SUD were more likely to have COPD, depression, and dual Medicare-Medicaid eligibility.

Abstract

Traumatic brain injury (TBI) is a common, fall-related injury among older adults. Studies have reported high rates of pre-existing alcohol and/or substance use disorders (AUD/SUD) among younger adults with TBI, however, less is known about AUD/SUD among older adults with TBI. We estimated the prevalence of pre-existing AUD/SUD among older adults hospitalized with TBI and identified demographic and clinical characteristics associated with AUD/SUD status. We conducted a retrospective cohort study using Medicare administrative claims data, including beneficiaries aged ≥65 years hospitalized with TBI between 2010-2017. Pre-existing AUD/SUD was defined using diagnostic codes during the 6 months pre-TBI and 3 months post-TBI. Among beneficiaries hospitalized with TBI (n = 20,350), prevalence of pre-existing AUD/SUD diagnoses was 8.4% (n = 1,713). AUD diagnoses were most common (7.1%); 1.8% had SUD diagnoses. Among those with any AUD/SUD, 84.8% had AUD and 20.9% had ≥1 SUD diagnoses. Opioid use disorder was the most common SUD (10.4% SUD diagnoses). Compared to Medicare beneficiaries without an AUD/SUD diagnosis, beneficiaries with a pre-existing AUD/SUD diagnosis had lower odds of being older (odds ratio (OR) 0.91; 95% confidence interval (CI): 0.90, 0.92), being female (OR 0.53; 95% CI 0.48, 0.59), higher odds of having chronic obstructive pulmonary disease (OR 2.04; 95% CI 1.82, 2.28) or depression (OR 1.50; 95% CI 1.34, 1.67), and higher odds of dual eligibility for Medicare and Medicaid (OR 1.26; 95% CI 1.12, 1.42). Older Medicaid beneficiaries hospitalized with TBI who have pre-existing AUD/SUD have unique clinical complexities and may benefit from integrated and targeted treatments.