History of healthcare use and disease burden in older adults with different levels of alcohol use. A register‐based cohort study

Abstract

Only a smaller part of all individuals with problematic alcohol use ever seek alcohol treatment. Knowledge of general help-seeking behavior in the health-care system can identify possibilities for prevention and intervention. The current study described health care use, burden of disease, and prior morbidities over a 15-year-period by current alcohol use behavior among Danish adults aged 60-70. The Danish National Health Survey 2013, and the baseline assessment of the Elderly Study (2014-2016), were linked to Danish national registers to collect annual information on health care use and morbidity 15 years prior to inclusion. Participants from the three largest Danish municipalities were divided into four groups with varying drinking patterns and no recent treatment, and one group of treatment-seeking individuals with a 12-month alcohol use disorder (AUD): 12-months abstinent (n=691), low- (n=1978), moderate- (n=602), and high-risk drinkers (n=467), and treatment-seekers with 12-months DSM-5 AUD (n=262). Negative binomial regression models were utilized to compare rates of health care use, and logistic regressions were used to compare odds of diagnoses. Low-, moderate-, and high-risk drinkers had similar rates of past health care utilization (Low risk mean yearly number of contacts for primary care 7.50 (yearly range 6.25-8.45), outpatient care 0.80 (0.41-1.32) and inpatient care 0.13 (0.10-0.21). Higher rates were observed for both 12-months abstinence (Adjusted RR=1.16-1.26) and AUD (ARR=1.40-1.60) compared to low-risk alcohol consumption. Individuals with AUD had higher odds of previous liver (Adjusted OR=6.30)-, ulcer (AOR=2.83) - and peripheral vascular disease (AOR 2,71). 12-months abstinence was associated with higher odds of diabetes (AOR=1.97), and ulcer disease (AOR=2.10). Looking back in time, older adults have had health care contacts regularly, with those receiving treatment for AUD having had the highest contact frequency and prevalence of alcohol-related diseases. Thus, these health care settings may provide possibilities for prevention and intervention.