Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Alcohol use disorder (AUD) is conceptualized as a dimensional phenomenon in the DSM-5, but electronic health records (EHRs) rely on binary AUD definitions according to the ICD-10. The present study classifies AUD severity levels using EHR data and tests whether increasing AUD severity levels are linked with increased comorbidity. METHODS: Billing data from two German statutory health insurance companies in Hamburg included n = 21,954 adults diagnosed with alcohol-specific conditions between 2017 and 2021. Based on ICD-10 alcohol-specific diagnoses, patients were classified into five AUD severity levels: 1 (F10.0, T51.0 or T51.9); 2 (F10.1); 3 (F10.2); 4 (F10.3/4); 5 (K70 + or one of the following diagnoses: K70.0-4, K70.9, K85.2, K85.20, K86.0, 10.5-9, E24.4, G31.2, G62.1, G72.1, I42.6, K29.2). Generalized estimating equation regression models for count data (Poisson distribution) were used to assess associations with the Elixhauser Comorbidity Score (ECS). RESULTS: Across the study period, the annual prevalence of any AUD diagnosis varied between 2.7% and 2.9%. A dose-response relationship was observed between AUD severity and ECS, indicating that individuals with higher AUD severity experience more comorbid conditions, particularly cardiovascular and liver diseases. CONCLUSIONS: The proposal to define AUD severity levels based on ICD-10 diagnoses allows for a more nuanced analysis of AUD in EHR data.
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,090
OpenAlex ID: W4414083544