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

Background and Aims: Older persons 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 persons 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: 50 years and older (n= 1741; 28% 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 eleven ASI items, were the independent variables: “Late Onset with Fewer Consequence (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 sociodemographic 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 (d) other psychiatric disorders. Findings: During the study period, 73.2% were hospitalized at least once, 57.3% were alcohol-related, 8.5% polydrug use and 18.5% 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=
Substance Use Disorder Among Older Adults: typologies, pathways and health outcomes
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