Narrowing differences in the rate of alcohol-related acute care admissions in the United States between women versus men, 2016-2023.

BACKGROUND

Although men have historically exhibited the higher levels of alcohol use and alcohol-related harm, sex differences in alcohol consumption have narrowed in recent decades. Whether similar convergence has occurred in the proportion of substance-related acute care encounters involving alcohol remains unclear.

METHODS

We conducted a retrospective longitudinal cohort study using national administrative claims from the Merative MarketScan Commercial and Multi-State Medicaid databases (January 2016 to December 2023). Individuals aged 16-64 years with at least one emergency department (ED) or inpatient encounter involving a non-nicotine substance-related diagnosis (ICD-10-CM F10-F19, excluding F17) were included. Alcohol involvement was defined using multiple classifications: any alcohol-related diagnosis, alcohol-only encounters, inpatient admissions with alcohol as the primary diagnosis, and acute alcohol-related morbidity identified using CDC external cause codes. We estimated monthly sex-specific trends in the proportion of substance-related encounters involving alcohol using generalized estimating equation models with quadratic time terms.

RESULTS

The cohort comprised 1,355,161 individuals (54.7% male, 45.3% female) with 5,190,680 substance-related ED and inpatient encounters. Among individuals with substance-related encounters, alcohol involvement was more common among males than females (61.5% vs. 43.2%). Across all alcohol-related outcomes, models demonstrated accelerating convergence in the sex gap over time (all p < 0.001). From 2016 to 2023, the male-female gap in the proportion of substance-related encounters involving alcohol narrowed by 6.0 percentage points (95% CI, 4.9-7.1), 4.7 points (95% CI, 3.6-5.8) for alcohol-only encounters, and 4.9 points (95% CI, 4.0-5.8) for inpatient admissions with alcohol as the primary diagnosis. Trends in total substance-related encounter volume did not differ by sex.

CONCLUSIONS

From 2016 to 2023, alcohol accounted for an increasing proportional share of substance-related acute care encounters among women relative to men, independent of changes in overall substance-related healthcare utilization volume.