Abstract
BackgroundEvidence on diseases caused by or associated with alcohol use disorders (AUDs) has been based on two meta-analyses including rather dated studies. The objective of this contribution was to estimate the risks of all-cause mortality and alcohol-attributable disease categories depending on a diagnosis of AUDs in a national sample for France.MethodsIn a national retrospective cohort study on all inpatient acute and rehabilitation care patients in Metropolitan France 2008–2012 (N = 26,356,361), AUDs and other disease categories were identified from all discharge diagnoses according to standard definitions, and we relied on in-hospital death for mortality (57.4% of all deaths).Results704,803 (2.7%) patients identified with AUDs had a threefold higher risk of death (HR = 2.98; 95% CI: 2.96–3.00) and died on average 12.2 years younger (men: 10.4, 95% CI: 10.3–10.5; women: 13.7, 95% CI: 13.6–13.9). AUDs were associated with significantly higher risks of hospital admission for all alcohol-attributable disease categories: digestive diseases, cancers (exception: breast cancer), cardiovascular diseases, dementia, infectious diseases, and injuries. Elevated risks were highest for liver diseases that were associated with about two-third of deaths in patients with AUDs (men: 64.3%; women: 71.1%).ConclusionsAUDs were associated with marked premature mortality and higher risks of alcohol-attributable disease categories. Our results support the urgent need of measures to reduce the burden of AUDs.
Highlights
Background/rationale Alcohol use is a major risk factor for burden of disease and injury [1, 2]
Alcohol use disorders Patients with AUDs were identified by any hospital record describing mental and behavioural states due to former or current harmful use of alcohol (ICD10 F10.1 to F10.9) or WHO International Classification of Diseases (ICD)-10 codes indicating a disease onset that is fully attributable to AUDs (e.g., K70 ‘Alcoholic Liver Disease’)
We examined hazard ratios under two assumptions: (i) one binary variable of AUDs status was introduced under the assumption of linearity of the effect of AUDs over lifetime; (ii) an age-varying effect of AUDs was estimated by introducing a third order polynomial of age
Summary
Background/rationale Alcohol use is a major risk factor for burden of disease and injury [1, 2]. In the European Union, in 2004, alcohol dependence, the most severe disabling of AUDs, was estimated to account for 62% of all burden from alcohol use [4] This contribution aims to quantify the hospitalization and mortality risks associated with AUD for all disease categories are causally related to alcohol, i.e., assuming level of ethanol exposure as the pathway between AUD and outcomes (general: [6]; for risk analyses of ethanol e.g.: [7, 8]).
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