Liver disease, frequency of alcohol-related care linked to mortality, hospital readmission
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Key takeaways:
- Across provinces, up to 20.3% of patients were readmitted after hospitalization and up to 12.1% died within 1 year.
- Those with liver disease and high frequency health care utilization were at higher risk.
Individuals with alcohol-related liver disease and frequent health care utilization were at greater risk for mortality and hospital readmission, respectively, according to a cohort study of alcohol-related hospitalizations in Canada.
“Alcohol-related hospitalizations are common among individuals with AUD and incur a large cost to health care systems around the world,” Erik L. Friesen, PhD, from the University of Toronto and the Center for Addiction and Mental Health, and colleagues wrote in JAMA Network Open. “As a result, there have been increasing efforts to understand the epidemiology of alcohol-related hospitalizations using population-based health administrative data.”
In a retrospective cohort study, Friesen and colleagues evaluated data from 34,043 patients hospitalized in Canada for alcohol-related harms between January 2017 to December 2018. The cohort included 4,753 individuals from Manitoba (median age, 49 years; 37.6% women) and 29,290 from Ontario (median age, 57 years; 29.1% women).
Using latent class analysis, researchers identified five clinical subgroups of hospitalized patients, ranging from low- to high-frequency care utilization:
- acute intoxication with a low average frequency of prior health care utilization (2.7% in Manitoba and 3.6% in Ontario);
- harmful alcohol use with few alcohol-related comorbidities and health care utilizations (29.2% and 19.4%, respectively);
- alcohol dependence with more alcohol-related comorbidities and average utilization (31.9% and 30.8%, respectively);
- withdrawal and high frequency (24.3% and 20.4%, respectively); and
- alcohol-related liver disease with the highest frequency of prior health care utilization (11.8% and 15.1%, respectively).
For Ontario, researchers added two additional groups: high frequency of all types of alcohol-related care utilization (5.2%) and high frequency of prior alcohol-related emergency department visits and hospitalizations but less frequent related outpatient visits (5.5%).
According to results, 5.4% of patients in Manitoba died during index hospitalization compared with 7.5% in Ontario. Of those who survived, 20.3% and 18.1%, respectively, were readmitted and 8.4% and 12.1% died within 1 year.
Patients in the liver disease subgroup had the highest risk for in-hospital (Manitoba: adjusted OR = 3.12; 95% CI, 1.22-7.96 and Ontario: aOR = 3.8; 95% CI, 2.6-5.53) and post-discharge mortality (aHR = 2.38; 95% CI, 1.07-5.3 and aHR = 3.85; 95% CI, 2.83-5.25, respectively) compared with those in the acute intoxication subgroup. In Ontario, this corresponded with a 1-year mortality risk of 31.2% vs. 4% between groups.
Further, individuals in Ontario with high frequency service utilization (10.6%) had a higher risk for 1-year readmission compared with the acute intoxication group (46.1% vs. 9.8%; aHR = 5.09; 95% CI, 4.11-6.31).
“This study identified distinct clinical subgroups of individuals hospitalized for alcohol-related harms,” Friesen and colleagues concluded. “These subgroups followed a severity gradient and those in the more severe categories accounted for most of the adverse in-hospital and post-discharge outcomes.”
They continued: “Efforts to reduce high rates of readmission and mortality among individuals experiencing alcohol-related hospitalizations may consider prioritizing those at the highest risk of short-term harm, including individuals with alcohol-related liver disease and high frequency health service use.”
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