Differing time trends for alcohol misuse and alcohol use disorder among Veteran men: A comparison of population surveillance and clinical data

Abstract

IntroductionData on time trends are important to track the health burden of alcohol use disorder (AUD) and plan for alcohol-related healthcare needs. Our aim was to estimate time trends in AUD for male VA patients and to assess whether trends in documented diagnosis rates were similar to trends in unhealthy alcohol use measured through clinical screening or trends in AUD prevalence among US veterans in the general population. Materials and methodsWe used VA electronic health record data (10/1/2009–9/30/2019) to measure AUD diagnosis rates and clinical alcohol screening data to measure unhealthy alcohol use. We used data from the National Survey on Drug Use and Health to measure AUD prevalence for 2010–2019. We estimated time trends using regression models with year entered as a linear term. ResultsFor male VA patients, AUD diagnosis rates increased overall and for most age groups, Alcohol screening rates increased, but the proportion with unhealthy alcohol use decreased, except among older patients. AUD prevalence for male US veterans decreased by −0.17 percentage points (pp) annually (p = 0.010), reflecting a strong decreasing trend for ages 18–34 years (−1.20 pp per year, p < 0.001). ConclusionsIncreasing trends in AUD diagnoses among VA patients are a contrast to the decreasing trends in unhealthy alcohol use and AUD population prevalence among male US veterans. However, differences in trends by age group highlights a need to better understand the process of clinical AUD identification, particularly for younger men.