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Alcohol dependence and physical comorbidity: Increased prevalence but reduced relevance of individual comorbidities for hospital-based mortality during a 12.5-year observation period in general hospital admissions in urban North-West England

Published online by Cambridge University Press:  15 April 2020

D. Schoepf  and
R. Heun
D. Schoepf*
Affiliation:
Department of Psychiatry, University of Bonn, Sigmund-Freud-Strasse 25, 53105Bonn, Germany
R. Heun
Affiliation:
Department of Psychiatry, University of Bonn, Sigmund-Freud-Strasse 25, 53105Bonn, Germany Department of Psychiatry, Radbourne Unit, Royal Derby hospital, Derby, United Kingdom
*
*Corresponding author. +49 228 287 16566. E-mail addresses:dieter.schoepf@ukb.uni-bonn.de, d.schoepf@t-online.de (D. Schoepf).
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Abstract

Purpose:

Alcohol dependence (AD) is associated with an increase in physical comorbidities. The effects of these diseases on general hospital-based mortality are unclear. Consequently, we conducted a mortality study in which we investigated if the burden of physical comorbidities and their relevance on general hospital-based mortality differs between individuals with and without AD during a 12.5-year observation period in general hospital admissions.

Methods:

During 1 January 2000 and 30 June 2012, 23,371 individuals with AD were admitted at least once to seven General Manchester Hospitals. Their physical comorbidities with a prevalence ≥ 1% were compared to those of 233,710 randomly selected hospital controls, group-matched for age and gender (regardless of primary admission diagnosis or specialized treatments). Physical comorbidities that increased the risk of hospital-based mortality (but not outside of the hospital) during the observation period were identified using multiple logistic regression analyses.

Results:

Hospital-based mortality rates were 20.4% in the AD sample and 8.3% in the control sample. Individuals with AD compared to controls had a higher burden of physical comorbidities, i.e. alcoholic liver and pancreatic diseases, diseases of the conducting airways, neurological and circulatory diseases, diseases of the upper gastrointestinal tract, renal diseases, cellulitis, iron deficiency anemia, fracture neck of femur, and peripheral vascular disease. In contrast, coronary heart related diseases, risk factors of cardiovascular disease, diverticular disease and cataracts were less frequent in individuals with AD than in controls. Thirty-two individual physical comorbidities contributed to the prediction of hospital-based mortality in univariate analyses in the AD sample; alcoholic liver disease (33.7%), hypertension (16.9%), chronic obstructive pulmonary disease (14.1%), and pneumonia (13.3%) were the most frequent diagnoses in deceased individuals with AD. Multiple forward logistic regression analysis, accounting for possible associations of diseases, identified twenty-three physical comorbidities contributing to hospital-based mortality in individuals with AD. However, all these comorbidities had an equal or even lower impact on hospital-based mortality than in the comparison sample.

Conclusion:

The excess of in-hospital deaths in general hospitals in individuals with AD is due to an increase of multiple physical comorbidities, even though individual diseases have an equal or even reduced impact on general hospital-based mortality in individuals with AD compared to controls.

Keywords

Alcohol dependencePhysical comorbidityGeneral hospitalsMortalityRisk Factors
Type
Original article
Information
European Psychiatry , Volume 30 , Issue 4 , June 2015 , pp. 459 - 468
Copyright
Copyright © Elsevier Masson SAS 2015

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References

Al-Sanouri, I, Dikin, M, Soubani, AOCritical care aspects of alcohol abuse. South Med J 2005;98(3):372–381.CrossRefGoogle ScholarPubMed
Bajaj, V, Vedi, S, Govil, S, Govil, R, Pathak, PSeizures in alcohol-dependent patients. MJP 2011.Google Scholar
Baliunas, DO, Rehm, J, Irving, H, Shuper, PAlcohol consumption and risk of incident human immunodeficiency virus infection: a meta-analysis. Int J Public Health 2010;55(3):159–166.CrossRefGoogle ScholarPubMed
Balla, AK, Doi, EM, Wunder, PR, Ogle, JD, DeBault, LEHuman polymorphonuclear leukocyte (PMN) priming and activation by acute ethanol intoxication. Adv Exp Med Biol 1993; 335: 165–168.CrossRefGoogle ScholarPubMed
Barclay, GA, Barbour, J, Stewart, S, Day, CP, Gilvarry, EAdverse physical effects of alcohol misuse. Advances in Psychiatric Treatment. 2008; 14: 139–151.CrossRefGoogle Scholar
Boulet, LP, Boulay, MEAsthma related comorbidities. Expert Rev Respir Med 2011;5(3):377–397.CrossRefGoogle ScholarPubMed
Chick, JAlcohol and the brain. Curr Opin Psychiatry 1997; 10: 205–210.CrossRefGoogle Scholar
Clark, BJ, Williams, A, Cecere Feemster, LM, Bradley, KA, Macht, M, Moss, Met al.Alcohol screening scores and 90-day outcomes in patients with acute lung injury. Crit Care Med 2013;41(6):1518–1525.CrossRefGoogle ScholarPubMed
Corrales-Medina, VF, Musher, DM, Wells, GA, Chirinos, JA, Chen, L, Fine, MJet al.Cardiac complications in patients with community-acquired pneumonia: incidence, timing, risk factors, and association with short-term mortality. Circulation 2012; 125: 773–781CrossRefGoogle ScholarPubMed
Corrao, G, Bagnardi, V, Zambon, A, La Veccia, CA meta-analysis of alcohol consumption and the risk of 15 diseases. Prevent Med 2004;38(5):613–619.CrossRefGoogle ScholarPubMed
American Psychiatric Association Diagnostic and statistical manual of mental disorders: DSM-5TM 2013.CrossRefGoogle Scholar
Di Castelnuovo, A, Constanzo, S, Bagnardi, V, Donati, MB, Iacoviello, L, de Gaetano, GAlcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies. Arch Intern Med 2006;166(22):2437–2445.CrossRefGoogle ScholarPubMed
Di Franza, JR, Guerrera, MPAlcoholism and smoking. J Stud Alcohol 1990; 51: 130–135CrossRefGoogle Scholar
Elixhauser, A, Steiner, C, Harris, R, Coffey, RMComorbidity measures for use of administrative data. Med Care 1998;36(1):8–27.CrossRefGoogle ScholarPubMed
Fauchier, L, Babuty, D, Poret, P, Casset-Senon, D, Autret, ML, Cosnay, Pet al.Comparison of long-term outcome of alcoholic and idiopathic dilated cardiomyopathy Eur Heart J 2000; 21: 306–314.CrossRefGoogle ScholarPubMed
Fudalej, S, Bohnert, A, Ausiin, K, Barry, K, Blow, F, IIgen, MPredictors of injury-related and non-injury-related mortality among veterans with alcohol use disorder. Addiction 2010;105(10):1759–1766.CrossRefGoogle Scholar
Gargiulo, G, Testa, G, Cacciatore, F, Mazella, F, Galizia, G, Della-Morte, Det al.Moderate alcohol consumption predicts long-term mortality in elderly subjects with chronic heart failure J Nutr Health Aging 2013; 17: 480–485.CrossRefGoogle ScholarPubMed
Gaziano, JM, Gaziano, TA, Glynn, RF, Sesso, HD, Ajani, UA, Stampfer, MJet al.Light-to-moderate alcohol consumption and mortality in the Physicians’ Health Study enrollment cohort J Am Coll Cardiol 2000; 35: 96–105CrossRefGoogle ScholarPubMed
George, LM, Maddock, KAccuracy of in-hospital activity notifications for infectious diseases. Br Med J 1979; 1: 1332–1339CrossRefGoogle Scholar
Gerke, P, Hapke, U, Rumpf, HJ, John, UAlcohol-related diseases in general hospital patients. Alcohol & Alcoholism 1997;32(2):179–184.CrossRefGoogle ScholarPubMed
Gossop, M, Domingos, N, Radovanovic, M, Batra, A, Toteva, S, Musalek, Met al.Physical health problems among patients seeking treatment for alcohol use disorders: a study in six European cities. Addict Biol 2007;12(2):190–196.CrossRefGoogle ScholarPubMed
Graham, D, Smith, JLThe course of patients after variceal haemorrhage. Gastroenterology 1981;80:800.CrossRefGoogle Scholar
Happel, KI, Nelson, SAlcohol, immunosuppression, and the lung. Proc Am Thorac Soc 2005; 2: 428–432.CrossRefGoogle ScholarPubMed
Heun, R, Schoepf, D, Potluri, R, Natalwala, AAlzheimer's disease and comorbidity: increased prevalence and possible risk factors of excess mortality in a naturalistic 7-year follow-up. Eur Psychiatry 2013;28(1):40–48.CrossRefGoogle Scholar
Irving, HM, Samokhvalov, AV, Rehm, JAlcohol as a risk factor for pancreatitis. A systematic review and meta-analysis. JOP 2009;10(4):387–392.Google ScholarPubMed
Joshi, PC, Guidot, DThe alcoholic lung: epidemiology, pathophysiology, and potential therapies. Am J Physiol Cell Physiol 2007; 292: 813–823Google ScholarPubMed
Kaner, EF, Beyer, F, Dickson, HO, Pienaar, E, Campbell, F, Schlesinger, Cet al.Effectiveness of brief alcohol care interventions in primary care populations. Cochrane Database Syst Rev 2007;18:CD004148.Google Scholar
Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EELifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry 2005; 62: 593–602CrossRefGoogle ScholarPubMed
Koivula, I, Sten, M, Makela, PHPrognosis after community-acquired pneumonia in the elderly: a population based 12-year follow-up study. Arch Intern Med 1999; 159: 1550–1555.CrossRefGoogle ScholarPubMed
Leone, M, Tonini, C, Bogliun, E, Monaco, F, Mutani, R, Bottacchi, Eet al.Chronic alcohol use and first symptomatic epileptic seizures. J Neurol Neurosurg Psychiatry 2002; 73: 495–499.CrossRefGoogle ScholarPubMed
Mann, RE, Smart, RG, Govonni, RThe epidemiology of alcoholic liver disease. Alcohol Res Health 2004.Google Scholar
Mannino, DM, Kiri, AChanging the burden of COPD mortality. COPD 2006;1(3):219–233.CrossRefGoogle ScholarPubMed
McMicken, D, Liss, JLAlcohol-related seizures. Emerg Med Clin North Am 2011;29(1):117–124.CrossRefGoogle ScholarPubMed
Mukamal, KJ, Maclure, M, Muller, JE, Sherwood, JB, Mittleman, MAPrior alcohol consumption and mortality following acute myocardial infarction. JAMA 2001; 285: 1963–1970CrossRefGoogle ScholarPubMed
National Institute on Alcohol Abuse Alcoholism (NIAAA) Alcohol and tobacco. Alcohol Alert. Rockville, MD: NIAAA; 1998. [No. 39].Google Scholar
Noone, PG, Leigh, MW, Sannuti, A, Minnix, SL, Carson, JL, Hazucha, Met al.Primary ciliary dyskinesia: diagnostic and phenotypic features. Am J Respir Crit Care Med 2004; 169: 459–467.CrossRefGoogle ScholarPubMed
Nutt, DAlcohol and the brain. Pharmacological insights for psychiatrists. Br J Psychiatry 1999; 175: 114–119.CrossRefGoogle ScholarPubMed
Nyhlen, A, Fridell, M, Bäckström, M, Hesse, M, Krantz, PSubstance abuse and psychiatric comorbidity as predictors of premature mortality in Swedish drug abusuers: a prospective longitudinal study 1970–2006. BMC Psychiatry 2011;11:122.CrossRefGoogle Scholar
Overad, TK, Ramussem, LH, Skjoth, F, Overvad, K, Albertsen, IE, Lane, DAet al.Alcohol intake and prognosis of atrial fibrillation. Heart 2013;99(15):1093–1099.CrossRefGoogle Scholar
Parracen, VJAlcoholic gastritis. Clin Gastroenterol 1981; 10: 289–399.Google Scholar
Phung, TK, Andersen, BB, Høgh, P, Kessing, LV, Mortensen, PB, Waldemar, GValidity of dementia diagnoses in the Danish in-hospital registers. Dement Geriat Cogn Disord 2007;24(3):220–228.CrossRefGoogle ScholarPubMed
Pott, JR, Goubet, S, Heneghan, MA, Verma, SDeterminants of long-term outcome in severe alcohol hepatitis Aliment Pharmacol Ther 2013; 38: 584–595CrossRefGoogle Scholar
Puddey, IB, Rakic, V, Dimmitt, SB, Bellin, LJInfluence of pattern of drinking on cardiovascular disease and cardiovascular risk factors: a review. Addiction 1999;94(5):649–663.CrossRefGoogle ScholarPubMed
Rehm, JThe risks associated with alcohol use and alcoholism. Alcohol Res Health 2011;34(2):135–143.Google ScholarPubMed
Rehm, J, Baliunas, DO, Borges, GLG, Graham, K, Irving, H, Kehoe, Tet al.The Relation between different dimensions of alcohol consumption and burden of disease – an overview. Addiction 2010;105(5):817–843.CrossRefGoogle ScholarPubMed
Rehm, J, Taylor, B, Mohapatra, S, Irving, H, Baliunas, D, Patra, Jet al.Alcohol as a risk factor for liver cirrhosis – a systematic review and meta-analysis. Drug Alcohol Rev 2010; 4: 437–445CrossRefGoogle Scholar
Rehm, J, Mathers, C, Popova, S, Thavorncharoensap, M, Teerawattananon, Y, Patra, JGlobal burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet 2009;373(9682):2223–2233.CrossRefGoogle ScholarPubMed
Riechlin, T, Orbes, I, Weis, M, Kaschka, WPAutonomic cardiac abnormalities in alcohol-dependent patients admitted to a psychiatric department. Clin Auton Res 1996; 6: 119–122.CrossRefGoogle Scholar
Roerecke, M, Rehm, JAlcohol use disorders and mortality: a systematic review and meta-analysis. Addiction 2013; 108: 1562–1578.CrossRefGoogle ScholarPubMed
Rumpf, HJ, Bohlmann, J, Hill, A, Hapke, U, John, UPhysicians low detection rates of alcohol dependence or abuse: a matter of methodological shortcomings?. Gen Hosp Psychiat 2001; 23: 133–137.CrossRefGoogle ScholarPubMed
Rydon, P, Redman, S, Sanson-Fisher, RW, Reid, ALDetection of alcohol-related problems in general practice. J Stud Alcohol 1992; 53: 197–202CrossRefGoogle ScholarPubMed
Samokhvalov, AV, Irving, H, Mohapatra, S, Rehm, JAlcohol consumption, unprovoked seizures, and epilepsy: a systematic review and meta-analysis. Epilepsia 2010;5(7):1177–1184.CrossRefGoogle Scholar
Samokhvalov, AV, Irving, HM, Rehm, JAlcohol consumption as a risk factor for atrial fibrillation: a systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil 2010;17(6):706–712.CrossRefGoogle ScholarPubMed
Schoepf, D, Heun, RAnxiety disorders and physical comorbidity: Increased prevalence but reduced relevance of specific risk factors for hospital-based mortality during a 12.5-year observation period in general hospital admissions. Eur Arch Psychiatry Clin Neurosci 2014 10.1007/s00406-014-0566-9 [Epub 2014 Dec 4].Google ScholarPubMed
Schoepf, D, Heun, RBipolar disorder and comorbidity: Increased prevalence and increased relevance of comorbidity for hospital-based mortality during a 12.5-year observation period in general hospital admissions. J Affect Dis 2014; 169: 170–178.CrossRefGoogle ScholarPubMed
Schoepf, D, Uppal, H, Potluri, R, Chandran, S, Heun, RComorbidity and its relevance on general hospital-based mortality in major depressive disorder: a naturalistic 12-year follow-up in general hospital admissions. J Psychiatr Res 2014; 52: 28–35CrossRefGoogle ScholarPubMed
Schoepf, D, Uppal, H, Potluri, R, Heun, RPhysical comorbidity and its relevance on mortality in schizophrenia: a naturalistic 12-year follow-up in general hospital admissions. Eur Arch Psychiatry Clin Neurosci 2014;264(2):3–28.CrossRefGoogle ScholarPubMed
Schoepf, D, Potluri, R, Uppal, H, Natalwala, A, Heun, RType-2 diabetes mellitus in schizophrenia: increased prevalence and major risk factor of excess mortality in a naturalistic 7-year follow-up. Eur Psychiatry 2012;27(1):33–42.CrossRefGoogle Scholar
Schoepf, D, Heun, R, Weiffenbach, O, Herrmann, S, Maier, WThe 4-week prevalence of somatoform disorders and associated psychosocial impairment. Nervenarzt 2003;74(3):245–251.CrossRefGoogle ScholarPubMed
Schuckit, MAAlcohol-use disorders. Lancet 2009;492–501.CrossRefGoogle ScholarPubMed
Seppä, K, Mäkelä, RHeavy drinking in hospital patients. Addiction 1993; 88: 1377–1382.CrossRefGoogle ScholarPubMed
Sisson, JHAlcohol and airway function in health and disease. Alcohol 2007;1(5):293–307.CrossRefGoogle Scholar
Stewart, SH, Finn, PR, Pihl, ROA dose-response study of the effects of alcohol on the perception of pain and discomfort due to electric shock in men at high familial-genetic risk for alcoholism. Psychopharmacology 1995; 119: 261–267.CrossRefGoogle ScholarPubMed
Stickel, F, Seitz, HKUpdate on the management of alcoholic steatohepatitis. J Gastrointestin Liver Dis 2013;22(2):189–197.Google ScholarPubMed
Taylor, B, Irving, HM, Baliunas, D, Roerecke, M, Patra, J, Mohapatra, Set al.Alcohol and hypertension: gender differences in dose-response relationships determined through systematic review and meta-analysis. Addiction 2009; 104: 1981–1990CrossRefGoogle ScholarPubMed
Thun, MJ, Richard Peto, FRS, Lopez, AD, Monaco, JH, Henley, SJ, Heath, CW Jr.et al.Alcohol consumption and mortality among middle-aged and elderly US adults. N Engl J Med 1997;337(24):1705–1714.CrossRefGoogle Scholar
Wilson, KC, Aukkonen, JJAcute respiratory failure from abused substances. J Intensive Care Med 2004;19(4):183–193.CrossRefGoogle ScholarPubMed
Wyatt, TA, Sisson, JH, Allen-Gipson, DS, McCaskill, ML, Boten, VA, De Vasure, JMet al.Co-exposure to cigarette smoke and alcohol decreases airway epitheliaö cell cilia beating in a protein kinase c∑-dependent manner. Am J Pathol 2012; 181: 431–440.CrossRefGoogle Scholar
Wyatt, TA, Sisson, JHChronic ethanol downregulates PKA activation and ciliary beating in bovine epithelial cells. Am J Physiol Lung Cell Mol Physiol 2001; 281: 575–581CrossRefGoogle Scholar
Yadav, D, Lowenfels, ABThe epidemiology of pancreatitis and pancreatic cancer. Gastroenterology 2013; 144: 1252–1261.CrossRefGoogle ScholarPubMed
Zakhari, SAlcohol and the cardiovascular system: molecular mechanisms for beneficial and harmful action. Alcohol Health Res World 1997; 21: 21–29.Google ScholarPubMed
Zambelis, T, Karandreas, N, Tzavellas, E, Kokotis, P, Liappas, JLarge and small fiber neuropathy in chronic alcohol-dependent subjects. J Peripher Nerv Syst 2005;10(4):375381. [RC].CrossRefGoogle ScholarPubMed
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