Impact of alcohol use disorder on inpatient hospitalizations: A comparison of outcomes between urban and rural Veterans Affairs hospitals

Background: Alcohol use disorder (AUD) is a leading cause of morbidity and mortality that disproportionately affects rural residents and Veterans. Objective: 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. Methods: 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. Results: 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). Conclusions: 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.