Alcohol use disorder links to higher mortality in IBD
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Alcohol use disorder correlated with a higher risk for in-hospital mortality among patients with inflammatory bowel disease, according to a presentation at Digestive Disease Week.
“It is reported that 54% of patients with Crohn's disease and 61% of patients with ulcerative colitis identify themselves as active drinkers. Among these IBD patients who are actively drinking, approximately half of them report moderate, heavy or binge drinking,” Mohamed Tausif Siddiqui, MD, Cleveland Clinic, and colleagues wrote. “Despite this, there is very limited literature studying the outcomes of alcohol use in patients with IBD and the large hospitalization record databases have never been explored to study this association.”
In a retrospective study, researchers used the Nationwide In-patient Sample database to identify adult patients diagnosed with IBD and hospitalized for alcohol use disorder (AUD). They further analyzed the differences in mortality, length of stay and associated cost as well as how hospitalizations associated with age, sex and race.
Of 641,525 hospitalizations (62.4% CD), 3.43% resulted from an AUD diagnosis; patients with IBD and AUD had higher all-cause in-hospital rates of mortality (17 per 1,000 hospitalizations; OR = 1.14; 95% CI, 1.03-1.06; adjusted OR = 1.18; 95% CI, 1.04-1.31) compared with patients without AUD (14 per 1,000 hospitalizations). Middle age (51 years-65 years: aOR = 3.4), male sex (aOR = 2.6) and Caucasian and Native American race (aOR = 1.2; aOR = 2.2) corelated with a higher risk for AUD. Researchers noted no significant differences between the two groups for length of stay, hospital cost, CD diagnosis or UC diagnosis.
“We found that there is a low, but considerable, proportion of IBD patients with AUD,” Siddiqui concluded. “The concurrent diagnosis of AUD is associated with a higher risk of mortality. Due to this higher risk, the screening of IBD patients for alcohol use should be advised and patients should be counseled accordingly.”
Perspective
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According to the CDC, excessive alcohol use is responsible for more than 95,000 deaths in the United States each year, or 261 deaths per day. These deaths shorten the lives of those who die by an average of almost 29 years, for a total of 2.8 million years of potential life lost. It is a leading cause of preventable death in the U.S. and cost the nation $249 billion in 2010.
So why would we not expect that alcohol abuse disorder would contribute to excess mortality in IBD patients? The only surprising aspect of the study is the paradox of why length of stay was not increased. I suspect that if you die, you may not stay in the hospital as long.
Along with opioid use, inadequate social support and psychologic impairments, alcohol abuse contributes to morbidity and mortality in IBD.
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Siddiqui M, et al. Abstract 254. Presented at: Digestive Disease Week; May 21-23, 2021 (virtual meeting).
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