Hospitalizations for Alcohol and Opioid Use Disorders in Older Adults: Trends, Comorbidities, and Differences by Gender, Race, and Ethnicity

Abstract

Background: The prevalence of substance use disorders (SUDs) among adults ages 65 and older has been increasing at a notably high rate in recent years, yet little information exists on hospitalizations for SUDs among this age group. In this study we examined trends in hospitalizations for alcohol use disorders (AUDs) and opioid use disorders (OUDs) among adults 65 and older in the United States, including differences by gender and race/ethnicity.

Methods: We used Medicare claims data for years 2007-2014 from beneficiaries ages 65 and older. We abstracted hospitalization records with an ICD-9 diagnostic code for an AUD or OUD. Hospitalization rates were calculated using population estimates from the United States Census. We examined trends in quarterly hospitalization rates for hospitalizations with AUD/OUD as primary diagnoses, and separately for those with these disorders as secondary diagnoses. We also examined comorbidities for those with a primary diagnosis of AUD/OUD. Analyses were conducted for all hospitalizations with AUD/OUD diagnoses, and separately by gender and race/ethnicity.

Results: Between the last quarter of 2007 and the third quarter of 2014, AUD hospitalization rates increased from 485 to 579 per million (19%), and OUD hospitalization rates from 46 to 101 per million (120%) and varied by gender (for AUD) and race/ethnicity (for both AUD and OUD). Hospitalization rates were particularly high for Black older adults, as was the increase in hospitalization rates. The increase in hospitalization rates was substantially higher for hospitalizations with AUD (84%) and OUD (269%) as secondary diagnoses.

Conclusions: Hospitalizations for AUDs and OUDs among older adults increased at an alarming rate during the observation period, and disparities existed in hospitalization rates for these conditions. Interventions focusing on the needs of older adults with AUD and/or OUD are needed, particularly to address the needs of a growing racially/ethnically diverse older adult population.

Keywords: Alcohol use disorders; hospitalizations; older adults; opioid use disorders.

Figure 1.

Quarterly alcohol use disorder hospitalization rates; U.S. older adults, 2007 quarter 4 to 2014 quarter 3.

Figure 2.

Quarterly opioid use disorder hospitalization rates; U.S. older adults, 2007 quarter 4 to 2014 quarter 3.

Figure 3.

Most common comorbidities for alcohol use disorder hospitalizations; U.S. older adults, 2007 quarter 4 to 2014 quarter 3. Note: ¹“W” in graph indicates that the prevalence rate of that comorbidity for men is significantly different from that of women, P < .0001. ²Letters within graph indicate that the comorbidity prevalence rate for that racial/ethnic group is significantly different than other racial ethnic group (W = White, B = Black, L = Latino, A = Asian, N = Native American) at the P < .05 level with Bonferroni correction for multiple comparisons. ³Mental disorders do not include alcohol use disorders, opioid use disorders, or any other substance use disorders.

Figure 4.

Most common comorbidities for opioid use disorder hospitalizations; U.S. older adults, 2007 quarter 4 to 2014 quarter 3. Note: ¹ “W” in graph indicates that the prevalence rate of that comorbidity for men is significantly different from that of women, P < .0001. ²Letters within graph indicate that the comorbidity prevalence rate for that racial/ethnic group is significantly different than other racial ethnic group (W = White, B = Black, L = Latino, A = Asian, N = Native American) at the P < .05 level with Bonferroni correction for multiple comparisons. ³Mental disorders do not include alcohol use disorders, opioid use disorders, or any other substance use disorders.

Figure 5.

Quarterly hospitalization rates for hospitalization with alcohol use disorder as secondary diagnosis; U.S. older adults, 2007 quarter 4 to 2014 quarter 3.

Figure 6.

Quarterly hospitalization rates for hospitalizations with opioid use disorder as secondary diagnosis in U.S. older adults, 2007 quarter 4 to 2014 quarter 3.