Age‐related impact of outcomes in hospitalized patients with alcohol overuse

TL;DR

Alcohol use disorder in hospitalized patients is linked to worse health outcomes, especially in older adults, highlighting the need for age-specific interventions.

Contribution

This study identifies age-specific clinical impacts of AUD in hospitalized patients using a large national database.

Findings

AUD patients had higher healthcare costs, longer stays, and worse discharge outcomes across all age groups.

Mortality risk was elevated in AUD patients under 70 but not in those over 70, suggesting survivor bias.

Coexisting sarcopenia and frailty in AUD patients conferred the highest mortality risk.

Abstract

The incidence of alcohol use disorder (AUD) and related complications, such as alcohol‐associated liver disease and alcohol‐associated cirrhosis, continues to rise in the United States. However, limited data exist on the impact of AUD in aging hospitalized populations. We aimed to evaluate the association between AUD and clinical outcomes in aging hospitalized patients.

We analyzed 2017–2020 data from the Nationwide Inpatient Sample, including adults aged 18–80 with and without AUD based on ICD‐10 codes (AUD: n = 523,464; general medical population [GMP]: n = 238,678). Primary outcomes included length of stay, discharge disposition, healthcare cost, mortality, sarcopenia, and frailty. Multivariable regression analyses were conducted within and across age strata (<50, 50–60, 61–70, 71–80 years).

Compared to the GMP, patients with AUD had higher healthcare utilization and more comorbidities across all age groups. A higher proportion of females were diagnosed with AUD in each age category. The prevalence of sarcopenia and frailty increased with age, with the highest rates in AUD patients over 70. Across all age groups, AUD was independently associated with worse outcomes, including increased sarcopenia, frailty, healthcare costs, longer hospital stays, and worse discharge dispositions. Mortality risk was elevated in AUD patients under 70 (odds ratios: 1.55, 1.41, 1.21 for <50, 50–60, 61–70, respectively), but not in those over 70 (OR: 0.95), suggesting survivor bias. Concurrent sarcopenia and frailty conferred greater mortality risk than either alone.

AUD is independently associated with worse clinical outcomes in hospitalized adults, especially older adults. These findings underscore the urgent need for age‐tailored alcohol intervention strategies.

In the Nationwide Inpatient Sample, alcohol use disorder (AUD) was independently associated with increased frailty, sarcopenia, longer hospital stays, higher costs, and adverse discharge outcomes across all age groups. Mortality was increased in AUD patients under 70 but not in those older than 70, suggesting survivor bias. The coexistence of frailty and sarcopenia conferred the highest mortality risk. Our findings highlight the need for targeted alcohol interventions and frailty/sarcopenia screening in older hospitalized patients with AUD.

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