Journal article
Impact of alcohol use disorder on inpatient hospitalizations: A comparison of outcomes between urban and rural Veterans Affairs hospitals
Journal of hospital medicine, Vol.20(5), pp.463-470
05/2025
DOI: 10.1002/jhm.13544
PMCID: PMC12047202
PMID: 39623486
Appears in UI Libraries Support Open Access
Abstract
Alcohol use disorder (AUD) is a leading cause of morbidity and mortality that disproportionately affects rural residents and Veterans.
To evaluate the burden of AUD in admissions at rural and urban hospitals within the Veterans Health Administration (VHA) comparing patient characteristics, clinical outcomes, and 1-, 3-, and 5-year mortality rates.
Retrospective cross-sectional study of patients admitted to VHA hospitals from 2016 to 2020, with a primary or secondary diagnosis related to AUD. Follow-up mortality data was collected through September 30, 2023.
From 2.9 million qualifying admissions, AUD-related diagnoses were present in 14.3% of admitted patients (427,375 admissions among 190,152 unique patients in 129 facilities). Rural hospitals (n = 22) had a significantly higher overall admission rate for AUD-related diagnoses (21.6% vs. 14.8%, p = .011), higher 30-day readmission rates (17.8% vs. 15.3%, p < .001), but lower hospital-level average length of stay (median = 4.3 vs. 5.6, p < .001). Mortality in rural hospitals was lower than urban at 1 year (9.6% vs. 11.4%, p < .001), 3 years (20.7% vs. 23.1%, p < .001), and 5 years (30.4% vs. 32.9%, p < .001).
Rural VHA hospitals have a higher proportion of patients admitted with AUD-related diagnoses and higher readmission rates, but lower mortality rates. Approximately, one in three patients admitted with an AUD-related diagnosis died within the 5-year follow-up period. The mortality rates observed are extraordinary and deserve urgent attention. A comprehensive plan to address AUD in the Veteran population, including how we approach and engage patients in treatment during hospitalizations with any primary or secondary AUD diagnoses, is needed.
Details
- Title: Subtitle
- Impact of alcohol use disorder on inpatient hospitalizations: A comparison of outcomes between urban and rural Veterans Affairs hospitals
- Creators
- James Willey - Iowa City VA Health Care SystemPeter Kaboli - Iowa City VA Health Care SystemAndrea Holcombe - Iowa City VA Health Care SystemAmy M J O'SheaTong Yu - University of IowaKelby Rewerts - Iowa City VA Health Care SystemGeorge Bailey - Iowa City VA Health Care SystemAnindita BandyopadhyayThad Abrams - Iowa City VA Health Care SystemJeydith T Gutierrez - Iowa City VA Health Care System
- Resource Type
- Journal article
- Publication Details
- Journal of hospital medicine, Vol.20(5), pp.463-470
- DOI
- 10.1002/jhm.13544
- PMID
- 39623486
- PMCID
- PMC12047202
- NLM abbreviation
- J Hosp Med
- ISSN
- 1553-5606
- eISSN
- 1553-5606
- Publisher
- Wiley; HOBOKEN
- Grant note
- PROJ-03852 / Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, Veterans Rural Health Resource Center- Iowa City. CIN 13-412 / Office of Research and Development, Health Services Research and Development (HSR&D) Service through the Comprehensive Access and Delivery Research and Evaluation (CADRE) Center
- Language
- English
- Electronic publication date
- 12/02/2024
- Date published
- 05/2025
- Academic Unit
- Neurology; Psychiatry; Epidemiology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984757070502771
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