Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep;117(9):2415-2430.
doi: 10.1111/add.15907. Epub 2022 May 9.

Recurrent risk of hospitalization among older people with problematic alcohol use: a multiple failure-time analysis with a discontinuous risk model

Wossenseged Birhane Jemberie  1   2   3 , Mojgan Padyab  1   2 , Dennis McCarty  4 , Lena M Lundgren  1   5
Affiliations

Recurrent risk of hospitalization among older people with problematic alcohol use: a multiple failure-time analysis with a discontinuous risk model

Wossenseged Birhane Jemberie et al. Addiction. 2022 Sep.

Abstract

Background and aims: Older people with problematic alcohol use vary in psychosocial functioning, age of onset for problem drinking and use of other drugs. The study measured the differential risks of all-cause, alcohol-, polydrug- and psychiatric-related repeated hospitalizations among older people with problematic alcohol use.

Design: A linked register-based cohort study with discontinuous multiple-failure (time-to-repeated-event) data. Hospitalization and mortality were considered as failure.

Setting: Sweden, March 2003-November 2017, using data from the Addiction Severity Index (ASI) register linked to National Inpatient Register and the Swedish cause of death register.

Participants: Participants aged 50 years and older (n = 1741; 28.2% women), with one or more alcohol problem days in the 30 days before an ASI assessment.

Measurements: Five mutually exclusive latent classes of problematic alcohol use, identified with 11 ASI items, were the independent variables: 'late onset with fewer consequences (LO:FC; reference group)'; 'early onset/prevalent multi-dimensional problems (EO:MD)'; 'late onset with co-occurring anxiety and depression (LO:AD)'; 'early onset with co-occurring psychiatric problems (EO:PP)'; and 'early onset with major alcohol problem (EO:AP)'. Covariates included socio-demographic characteristics, previous hospitalization and Elixhauser comorbidity index. Outcome measurements included recurrent hospitalization and/or mortality due to: (a) all-cause, (b) alcohol-related disorders and diseases (c) polydrug use and (d) other psychiatric disorders.

Findings: During the study period, more than 75% were hospitalized at least once or died. 57.3% were hospitalized with alcohol-related, 8.5% with polydrug use and 18.5% with psychiatric-related diagnoses. Compared with LO:FC, EO:PP had higher risk for all-cause [adjusted hazard ratio (aHR) = 1.27, 95% confidence interval (CI) = 1.02-1.59] and alcohol-related (aHR = 1.34, 95% CI = 1.02-1.75) hospitalizations. Adjusted risks for polydrug-related hospitalization were 2.55, 95% CI = 1.04-6.27 for EO:MD and 2.62, 95% CI = 1.07-6.40 for EO:PP. Adjusted risk for psychiatric-related hospitalization was higher for LO:AD (aHR = 1.78, 95% CI = 1.16-2.73 and EO:PP (aHR = 2.03, 95% CI = 1.22-3.38).

Conclusions: Older addiction service users in Sweden have varying risks of hospitalization due to alcohol use, polydrug use and psychiatric disorders. Older people with problematic alcohol use who have multiple needs and are assessed in social services may benefit from earlier interventions with an integrated focus on substance use and mental health.

Keywords: Addiction care; addiction services; aged; at-risk alcohol consumption; dual diagnoses; heavy drinking; hospital re-admission; longitudinal study; mental health disorder; substance use disorder.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Analysis cohort
FIGURE 2
FIGURE 2
Total number of failures (hospitalization and mortality) among five classes of harmful alcohol use. LO/functional, late onset/functional with fewer consequences; EO/multi‐dimensional problem, early onset/multi‐dimensional problems; LO/with anxiety‐depression, late onset with co‐occurring anxiety and depression; EO/psychiatric problem, early onset with co‐occurring psychiatric problems; EO/major alcohol problem, p;early onset/major alcohol problem
FIGURE 3
FIGURE 3
Percentage of individuals with at least one event stratified according to the five classes. LO/functional, late onset/functional with fewer consequences; EO/multi‐dimensional problem, early onset/multi‐dimensional problems; LO/with anxiety‐depression, late onset with co‐occurring anxiety and depression; EO/psychiatric problem, early onset with co‐occurring psychiatric problems; EO/major alcohol problem, early onset/major alcohol problem. Note: The percentages do not add to 100 because of overlap within the outcome categories
See this image and copyright information in PMC

References

    1. Ahlner F, Sigström R, Rydberg Sterner T, Mellqvist Fässberg M, Kern S, Östling S, et al. Increased alcohol consumption among Swedish 70‐year‐olds 1976 to 2016: analysis of data from the Gothenburg H70 birth cohort studies, Sweden. Alcohol Clin Exp Res. 2018;42:2403–12. - PubMed
    1. Han BH, Moore AA, Ferris R, Palamar JJ. Binge drinking among older adults in the United States, 2015 to 2017. J Am Geriatr Soc. 2019;67:2139–44. - PMC - PubMed
    1. Soler‐Vila H, Ortolá R, García‐Esquinas E, León‐Muñoz LM, Rodríguez‐Artalejo F. Changes in alcohol consumption and associated variables among older adults in Spain: a population‐based cohort study. Sci Rep. 2019;9:10401. - PMC - PubMed
    1. Kuerbis A. Substance use among older adults: an update on prevalence, etiology, assessment, and intervention. Gerontology. 2020;66:249–58. - PubMed
    1. Van Montfoort‐De RKFG, De Weert‐Van OGH, Beurmanjer H, Koekkoek B. Late‐onset alcohol dependence: patient‐reported problems. Addict Res Theory. 2017;25:139–45.

Publication types