Between 1998 and 2016, hospitalization rates for alcohol use disorder (AUD) increased significantly in patients with gout, rheumatoid arthritis (RA), fibromyalgia, osteoarthritis (OA), and low back pain (LBP), according to study results published in the Journal of Clinical Rheumatology. Further, patients with any of these 5 musculoskeletal diseases (MSDs) had a higher likelihood of a hospital stay of more than 3 days.
In patients with MSDs, alcohol use is associated with disease flares and poor outcomes. This study was conducted to measure the rates of AUD hospitalization in patients with 5 MSDs, including gout, RA, fibromyalgia, OA, and LBP, and to evaluate hospital-related outcomes.
The researcher used data from the National Inpatient Sample (NIS) from 1998 to 2016. The NIS is a 20% stratified sample of all discharges from community hospitals in the US. A study cohort of all hospitalizations with AUD as the primary diagnosis was identified using International Classification of Diseases, Ninth Revision (ICD-9) or International Classification of Diseases, 10th Revision (ICD-10) codes. Within the cohort, patients with concomitant MSD (gout, RA, fibromyalgia, OA, or LBP) as a secondary diagnosis were also identified using the ICD codes. Multivariable-adjusted (age, sex, race, and income) utilization outcomes (total hospital charges and length of stay) and in-hospital mortality were compared between patients with and without each MSD.
During the study period, there was a 3- to 4.5-fold increase in AUD hospitalization rates in patients with MSDs (3-fold increase in gout, RA, and LBP; 3.5-fold increase in OA; and 4.5-fold increase in fibromyalgia). Patients with gout had $3913 higher adjusted total hospital charges than individuals without gout. Adjusted total hospital charges were lower for patients with fibromyalgia, OA, and LBP and similar for RA, compared with those without each condition. Patients with any of the 5 MSDs had a greater likelihood of a hospital stay of more than 3 days. Adjusted odds ratios were 1.34 for gout, 1.17 for RA, 1.13 for fibromyalgia, 1.12 for OA, and 1.10 for LBP. The likelihood of in-hospital mortality was lower for all 5 MSDs; odds ratios ranged from 0.21 for fibromyalgia to 0.58 for RA.
Study limitations included a lack of information on the cause of death for AUD hospitalizations, misclassification bias in the use of diagnostic codes to identify the study cohort, the observational design of the study, use of hospital charges that are inflated over the actual costs, missing data for race and total hospital charges, potential inclusion of multiple hospitalizations per person in the analyses due to the lack of patient identifiers, and the time lag in reporting in the NIS, which prevented inclusion of the most recent 2017 dataset.
The researcher concluded, “The primary care providers who treat most of the patients with gout, LBP, OA, and fibromyalgia should consider assessment for and direct counseling regarding substance use disorders, including AUD, to patients with these conditions. Referral of MSD patients with severe depression and/or AUD to psychiatry should be a priority. Rheumatologists should consider screen[ing] patients with RA, OA, and fibromyalgia referred to them for further diagnosis and treatment, for AUD and other substance disorders, during the initial history and examination.”
Disclosure: The study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of the author’s disclosures.
Singh JA. Epidemiology and outcomes of alcohol use hospitalizations in people with gout, rheumatoid arthritis, fibromyalgia, osteoarthritis, or low back pain: A national study. J Plinical Rheumatol. Published online March 25, 2021. doi:10.1097/RHU.0000000000001731