Diabetes, hypertension, COPD, liver disease all associated with heavy drinking

People with several of the most common chronic conditions were more likely to drink alcohol to excess, a recently published study found.

“Patients with most medical conditions, compared with those without, were more likely to report no alcohol use than to drink at low-risk or high-risk levels,” wrote study first author Stacy Sterling, DrPH, of Kaiser Permanente Northern California, and colleagues, in JAMA Network Open. “However, people with diabetes, hypertension, chronic obstructive pulmonary disease (COPD), and chronic liver disease who reported drinking were more likely than those without to drink at unhealthy levels, potentially exacerbating their conditions and jeopardizing treatment regimens.”

Approximately 65,000 Americans die each year from causes attributable to alcohol use, Sterling and colleagues pointed out. In the U.S., at least 25% of adults overall and as much as 20% of adult primary care patients exceed federal guidelines for alcohol use — no more than 4 drinks per day or 14 per week for men 18-64 years of age or no more than 3 per day or 7 per week for women and for men who are older than 65 years.

Sterling and colleagues used electronic health record data collected during clinical care to “help better identify the associations between medical conditions and levels of alcohol use and may aid primary care clinicians in specific disease management strategies targeted at particularly vulnerable patients.”

Information was collected during adult primary care visits to Kaiser Permanent North California in June 2013 as part of an alcohol-use screening and intervention initiative. Questions were formulated using the National Institute on Alcohol Abuse and Alcoholism’s guide for primary care clinicians, with data categorized by level of reported alcohol use: no use, low-risk use, exceeding daily limits, exceeding weekly limits, or exceeding both daily and weekly limits.

Then, the study team extracted diagnosis codes from the year prior to the screenings, examining 20 common medical conditions: asthma, atherosclerosis, atrial fibrillation, chronic kidney disease, chronic liver disease, COPD, coronary disease, diabetes, dementia, epilepsy, gastroesophageal reflux, heart failure, hyperlipidemia, hypertension, migraine, osteoarthritis, osteoporosis/osteopenia, Parkinson disease, peptic ulcer, and rheumatoid arthritis. Additionally, Sterling and colleagues examined cancer as well as conditions associated with unhealthy levels of alcohol use such as arthritis, cerebrovascular disease, chronic pain, HIV, and injury or poisoning.

Among the 2,720,231 patients ultimately included, 1,439,361 (52.9%) were female, 1,308,659 (48.1%) were white, and 883,276 (32.5%) were age 18-34 years. In the full sample, 1,858,804 (68.3%) people reported no alcohol use in the prior 90 days, 592,048 (21.8%) reported low-risk use, 165,581 (6.1%) reported exceeding daily limits, 62,349 (2.3%) reported exceeding weekly limits, and 41,449 (1.5%) reported exceeding both daily and weekly limits.

Among 861,427 patients reporting alcohol use, patients with diabetes (OR 1.11; 95% CI 1.08-1.15), hypertension (OR 1.11; 95% CI 1.09-1.13), COPD (OR 1.16; 95% CI 1.10-1.22), or injury or poisoning (OR 1.06; 95% CI 1.04-1.07) had higher odds of exceeding daily limits only.

Those with atrial fibrillation (OR 1.12; 95% CI 1.06-1.18), cancer (OR 1.06; 95% CI 1.03-1.10), COPD (OR 1.15; 95% CI 1.09-1.20), or hypertension (OR 1.37; 95% CI 1.34-1.40) had higher odds of exceeding weekly limits only. People with COPD (OR 1.15; 95% CI 1.07-1.23), chronic liver disease (OR 1.42; 95% CI 1.32-1.53), or hypertension (OR 1.48; 95% CI 1.44-1.52) had higher odds of exceeding both daily and weekly limits.

Patients with medical conditions were more likely to report no use, a finding experts believed was not surprising given the alcohol abstinence often found among people in poorer health. However, several data points were eye-opening to one expert not affiliated with the study, with evidence showing alcohol can make a particularly problematic combination with several of the conditions examined.

“In adjusted analyses among patients reporting any alcohol use, those with chronic liver disease, COPD, hypertension, and diabetes were more likely than those without to report patterns of unhealthy alcohol use,” wrote Emily Williams, PhD, MPH, of the health services department at the University of Washington School of Public Health, in an accompanying editorial. “This is concerning because these conditions contribute substantially to the burden of morbidity and mortality in the U.S. and are exacerbated by alcohol use.”

When identifying study limitations, Sterling and colleagues noted their inability to establish temporality of associations between medical conditions and alcohol consumption. Future studies, they said, should work to establish that temporality.

Williams urged an increase in alcohol-use screenings in primary care, particularly among those who may be vulnerable to abuse.

“Although policy and other macro-level solutions will likely be necessary to combat the increasing burden of alcohol use in the U.S., capitalizing on information obtained from routine alcohol screening to improve clinical care could represent a stronghold in addressing this growing public health crisis,” Williams wrote. “Specifically… this information may help clinicians understand the prevalence of any alcohol use and unhealthy alcohol use in key clinical subpopulations at increased risk of alcohol-related harm.”

  1. While people with most medical conditions are likely to abstain from alcohol, those with chronic conditions such as diabetes, hypertension, COPD, or chronic liver disease appear more likely to drink alcohol to excess.

  2. These chronic conditions contribute substantially to the burden of morbidity and mortality in the U.S. and are exacerbated by alcohol use, experts note.

Scott Harris, Contributing Writer, BreakingMED™

No source appearing in this article disclosed any relevant financial relationship with industry.

Cat ID: 142

Topic ID: 86,142,102,6,12,111,935,142,192,669,144,154,195,916,918,925