National Prevalence of Alcohol and Other Substance Use Disorders Among Emergency Department Visits and Hospitalizations: NHAMCS 2014-2018

Abstract

Background: Acute healthcare utilization attributed to alcohol use disorders (AUD) and other substance use disorders (SUD) is rising.

Objective: To describe the prevalence and characteristics of emergency department (ED) visits and hospitalizations made by adults with AUD or SUD.

Design, setting, and participants: Observational study with retrospective analysis of the National Hospital Ambulatory Medical Care Survey (2014 to 2018), a nationally representative survey of acute care visits with information on the presence of AUD or SUD abstracted from the medical chart.

Main measures: Outcome measured as the presence of AUD or SUD.

Key results: From 2014 to 2018, the annual average prevalence of AUD or SUD was 9.4% of ED visits (9.3 million visits) and 11.9% hospitalizations (1.4 million hospitalizations). Both estimates increased over time (30% and 57% relative increase for ED visits and hospitalizations, respectively, from 2014 to 2018). ED visits and hospitalizations from individuals with AUD or SUD, compared to individuals with neither AUD nor SUD, had higher percentages of Medicaid insurance (ED visits: AUD: 33.1%, SUD: 35.0%, neither: 24.4%; hospitalizations: AUD: 30.7%, SUD: 36.3%, neither: 14.8%); homelessness (ED visits: AUD: 6.2%, SUD 4.4%, neither 0.4%; hospitalizations: AUD: 5.9%, SUD 7.3%, neither: 0.4%); coexisting depression (ED visits: AUD: 26.3%, SUD 24.7%, neither 10.5%; hospitalizations: AUD: 33.5%, SUD 35.3%, neither: 13.9%); and injury/trauma (ED visits: AUD: 51.3%, SUD 36.3%, neither: 26.4%; hospitalizations: AUD: 31.8%, SUD: 23.8%, neither: 15.0%).

Conclusions: In this nationally representative study, 1 in 11 ED visits and 1 in 9 hospitalizations were made by adults with AUD or SUD, and both increased over time. These estimates are higher or similar than previous national estimates using claims data. This highlights the importance of identifying opportunities to address AUD and SUD in acute care settings in tandem with other medical concerns, particularly among visits presenting with injury, trauma, or coexisting depression.

Keywords: alcohol use disorder; emergency service; hospitalization; national; opioid use disorders; prevalence; substance use disorders; substance-related disorders.

Figure 1

National Prevalence of Alcohol Use Disorder (AUD) and/or other substance use disorders (SUD) among adult emergency department visits and hospitalizations. Data source: National Hospital Ambulatory Medical Care Survey. Weighted average annual number of emergency department visits and hospitalizations for individuals with AUD/SUD from 2014 to 2018 were 9,284,400 and 1,362,600, respectively. Both ED visits and hospitalizations made by individuals with AUD/SUD increased significantly over time (AUD/SUD ED visits: p=0.04, AUD/SUD Hospitalizations: p<0.001 for trend). Visits by individuals with AUD/SUD include visits made by individuals with AUD, SUD, or both conditions.