|Year : 2013 | Volume
| Issue : 2 | Page : 68-73
Prevalence of medical comorbidity in alcohol dependence syndrome
S Chandini, P John Mathai
Department of Psychiatry, Father Muller Medical College, Mangalore, India
|Date of Web Publication||16-Sep-2013|
P John Mathai
Department of Psychiatry, Father Muller Medical College, Mangalore
Source of Support: None, Conflict of Interest: None
Objective: Diverse medical conditions are associated with alcohol use disorders. Early diagnosis, prompt intervention, and treatment will reduce the morbidity and mortality and improve the quality of life. The aims of this study are to evaluate the frequency and nature of medical comorbidity in inpatients with alcohol dependence syndrome and to study the relationship between medical comorbidity and clinical and sociodemographic factors. Materials and Methods: This is an observational, descriptive, cross-sectional clinical study conducted on 100 consecutive patients with ICD10 diagnosis of alcohol dependence syndrome admitted to the deaddiction center, department of psychiatry, Father Muller Medical College Mangalore. All patients were assessed for evidence of concurrent medical comorbidity. Appropriate scales were used for assessment. Medical diagnosis was based on clinical findings, laboratory, and radiological investigations. The data of 100 patients were analyzed with appropriate statistical methods. Results: 65% of inpatients with alcohol dependence syndrome have medical comorbidity, of which 23% of alcohol-dependent individuals have diabetes mellitus, 20% have hypertension, and 51% of subjects have other medical comorbidities. Conclusion: The prevalence of medical comorbidity particularly diabetes mellitus and hypertension is significantly higher in inpatients with alcohol dependence syndrome. Our findings points to the importance for the need for early diagnosis of comorbid medical diseases.
Keywords: Alcohol dependence syndrome, medical comorbidity, prevalence
Key Messages: Anti-TPO antibody estimation is a very useful test for establishing the etiological diagnosis of autoimmune thyroid diseases. In certain situations it is an effective substitute for an invasive fine needle aspiration
|How to cite this article:|
Chandini S, Mathai P J. Prevalence of medical comorbidity in alcohol dependence syndrome. Muller J Med Sci Res 2013;4:68-73
|How to cite this URL:|
Chandini S, Mathai P J. Prevalence of medical comorbidity in alcohol dependence syndrome. Muller J Med Sci Res [serial online] 2013 [cited 2020 May 31];4:68-73. Available from: http://www.mjmsr.net/text.asp?2013/4/2/68/118227
| Introduction|| |
Alcohol dependence syndrome is a chronic disease with complex genetic, neurobiological, psychosocial, and environmental underpinnings. Alcohol use disorders have been associated with more than 60 different medical conditions and up to 40% of hospitalized patients with alcohol dependence syndrome receive treatment for medical complications.  A large epidemiological study of members of two culturally distinct tribes from the Southwest and the Northern Plains reported that the medical conditions that had significant relationships with alcohol dependence were sprains and strains, hearing and vision problems, kidney and bladder problems, head injuries, pneumonia, tuberculosis, dental problems, liver problems, and pancreatitis.  Medical comorbidity in a hospital-based cohort of alcohol-dependent patients assessed with the Cumulative Illness Rating Scale (substance abuse) showed that the organs/systems most affected were liver (99%), respiratory (86%), and cardiovascular (58%) and 50% of patients with severe medical comorbidity died in the first decade after treatment.  Researchers observed 6- to 13-fold and 4- to 6-fold excess rates of subjects with brain infarction among diabetics and alcohol users respectively. Researchers concluded that diabetes, alcoholism, and both in combination were associated with brain infarction.  It is reported that patients with alcoholism were more likely to have a diagnosis of obstructive lung disease, injuries, gout, hypertension, arthritis, and diabetes.  Several studies show a progressive rise in blood pressure throughout the entire range of alcohol consumption. Individuals consuming an average of three or more glasses of alcohol per day have three to four times the prevalence of "hypertension" ,,,, which predisposes to renal disease  and stroke. 
General and validated cause-specific mortality, especially regarding coronary disease was studied in a population-based cohort of 1049 alcohol-dependent men whereas coronary disease contributed to 19% of mortality.  Thun et al, reported that the comorbidity with alcohol-dependent individuals were cirrhosis liver, cancers of the mouth, esophagus, pharynx, larynx, and liver; breast cancer in women; and injuries and other external causes in men.  It was noted that alcohol-dependent patients had higher rates of sepsis, organ failure, septic shock, and hospital mortality. Sepsis and liver disease carried higher odds of death for alcohol-dependent patients than for those without alcohol dependence. 
Researchers have reported an increased prevalence of type 2 diabetes among individual with alcohol dependence. , Alcohol consumption is also a marker for poorer adherence to diabetes self-care behaviors.  Researchers have also observed impairment of the immune system with decreased ability to deal with infection or cancer, increased incidence of hypertension, cardiac arrhythmia, myocardial infarction and cardiomyopathy, increased incidence of stroke, increased incidence of esophageal and other cancers, cirrhosis and other liver disease, malnutrition among patient with alcohol dependence.  The prevalence of metabolic syndrome was twice as high in men and women with alcohol dependence compared to control subjects. Researchers have reported an increased rate of metabolic syndrome, increased blood pressure, and dysregulation of glucose and lipid metabolism in alcohol-dependent patients. 
Alcohol-dependent individuals have increased susceptibility to bacterial pneumonia, tuberculosis, and other infectious diseases. ,, Streptococcus pneumonia was found significantly more frequent in patients with alcohol dependence.  Higher prevalence of hepatitis C and HIV infections was noted among people with alcohol use disorders. 
- To evaluate the frequency and nature of medical comorbidity in inpatients with alcohol dependence syndrome.
- To study the relationship between medical comorbidity and clinical factors of alcohol dependence.
- To study the relationship between medical comorbidity and sociodemographic factors.
| Materials and Methods|| |
The clinical study was conducted in the deaddiction center, Department of psychiatry, Father Muller's Medical College, Mangalore. All patients admitted in the deaddiction center from July 2012 to December 2012 constituted the population for the investigation. One hundred consecutive inpatients who satisfied the inclusion and exclusion criteria were selected as the sample for the study. The inclusion criteria were inpatients with ICD DCR-10 diagnosis of alcohol dependence syndrome, age group between 20 and 60 years, male/female patients. Patients with substance dependence other than nicotine and presence of comorbid psychiatric disorder were excluded from the study. The tools used for investigation were (1) specially designed proforma to collect and document the sociodemographic and clinical data of alcohol dependence, (2) the socioeconomic status schedule (SESS) to assess the socioeconomic status of the patients [Sodhi and Sharma 1986]. 
The methods for assessment for medical comorbidity in patients admitted with alcohol dependence syndrome included the following: 1. Thorough clinical examination. 2. Laboratory investigations (CBC, RBS, RFT, LFT, TSH, ECG) 3. Other investigation when required (TMT, ECHO, EEG, brain imaging). 4. Medical, endocrinology, cardiology, neurology consultation when required.
This investigation is an observational, descriptive, cross-sectional clinical study. This study has been cleared by the institutional ethical committee. The design and nature of the clinical study was explained to the patients and to significant relatives of patients. A written informed consent was obtained from all the subjects. All the patients (n = 100) were subjected to a thorough clinical examination which included physical and mental status examination. When indicated extended neurological examination was carried out to rule out neurobehavioral disorders. The sociodemographic data were collected and recorded in the specially designed proforma. The socioeconomic class was assessed using the socioeconomic status schedule. Samples for routine laboratory investigations were sent. This included samples for CBC, RBS, RFT, LFT, TSH. ECG was taken for all the patients when they were cooperative for the same. Other investigations such as TMT, echocardiography, CT scan brain, MRI brain, EEG, and others suggested by consultants were carried out when required.
The diagnosis of medical diseases was confirmed by consultants from general medicine, neurology, and/or endocrinology. The collected data were analyzed by frequency, percentage, mean, standard deviations. The data were further analyzed using the chi-square test, t-test (independent and paired), ANOVA, and Karl Pearson correlation coefficient.
| Results|| |
Of the 100 patients assessed with alcohol dependence syndrome, no statistically significant difference is noted in the sociodemographic domains of age, marital status, religion, domicile, occupation, and SESS. A statistically significant difference is noted in domains of educational status (P = 0.002) [Table 1].
Association of Medical Comorbidity with Clinical Variables
Univariate and multivariate analyses are used to find the correlation of medical comorbidity with clinical variables. No statistically significant differences were noted in the total duration of alcohol use, daily drinking, morning drinking, and quantity of alcohol use. The prevalence of medical comorbidity is more among early onset alcohol use (69.4%); however no statistically significant difference is noted. A statistically significant difference is noted among alcohol-dependent individuals who had past history of delirium (P = 0.013) [Table 2].
Prevalence and Nature of Medical Comorbidity
Of the 100 individuals with alcohol dependence, 65% (n = 65) had medical comorbidity. A statistically significance difference is noted among alcohol-dependent individuals who had medical comorbidity (P = 0.031). On further analysis it is noted that 57.1% (n = 36) of alcohol-dependent individuals with withdrawal state uncomplicated and 78.4% (n = 29) of alcohol-dependent individuals with delirium have medical comorbidity [Table 3].
In this investigation, 23% of alcohol-dependent individuals have diabetes mellitus, 20% have hypertension, and 51% of subjects have other medical comorbidity. Comparing medical comorbidity among alcohol-dependent individuals a statistically significant difference is noted in alcohol-dependent individuals who have diabetes mellitus (P = 0.027) and other medical comorbidities (P = 0.003) [Table 4].
| Discussion|| |
This investigation is conducted in Father Muller Medical College Hospital which is a multispecialty general teaching hospital in Mangalore. The results of this investigation indicate that concurrent medical comorbidity is common in alcohol-dependent individuals. Sixty-five percent of inpatients with alcohol dependence have at least one concurrent medical comorbidity. A total of 57.1% of subjects with alcohol dependence syndrome withdrawal state uncomplicated and 78.4% of patients with alcohol dependence syndrome with delirium have concurrent medical comorbidity. Diabetes mellitus, hypertension, and other medical conditions are the most common medical comorbidities. Others medical comorbidites are chronic obstructive pulmonary disease, bronchial asthma, pneumonia, ischemic heart disease, chronic cardiac failure, dyslipedemia, hypothyroidism, portal hypertension, liver disease, liver hemangioma, esophageal candidiasis, pancreatitis, irritable bowel disease, cholelithiasis, right inguinal hernia, benign prostate hypertrophy, varicose veins, hemorrhoids, CSOM, lumbar spondylosis, lichenoid skin reaction, psoriasis, tinea corporis, hepatitis B, and HIV infections.
Earlier studies report that there is excess mortality and medical comorbidity in alcohol-dependent individuals. ,,, In the current investigation 23% of alcohol-dependent individuals have diabetes mellitus, 20% have hypertension, and 51% of subjects have other medical comorbidity. The results of this study are in concordance with those of the earlier studies. ,,,,,
The medical comorbidity does not have any significant relationship to the socidemographic factors. But significant difference is noted among low educational status. The medical comorbidity does not have any significant relationship to age of onset of alcohol use, duration of alcohol use or any other clinical variable. A statistically significant difference is noted among alcohol-dependent individuals who had past history of delirium.
This investigation is an observational, descriptive, cross-sectional clinical study. This study has certain merits and limitations. Although selection bias is avoided the sample is not representative of the general population of such patients. The sample size is inadequate. The assessment is not double blind and hence assessment bias is possible. The outpatients are not investigated.
Future studies with better methodology are required to draw definite conclusions. A much larger representative sample without selection bias and more rigorous and unbiased assessment for medical comorbidity are required.
The following are the conclusions of this clinical investigation on medical comorbidity in inpatients with alcohol dependence syndrome.
- 65% of inpatients with alcohol dependence have medical comorbidity.
- 23% of alcohol-dependent individuals have diabetes mellitus, 20% have hypertension, and 51% of subjects have other medical comorbidity.
- 57.1% of subjects with alcohol dependence syndrome withdrawal state uncomplicated and 78.4% of patients with alcohol dependence syndrome with delirium have concurrent medical comorbidity.
- The medical comorbidity is not related to any of the sociodemographic variables except educational status.
- The medical comorbidity is not related to the clinical variables such as age of onset, duration, and quantity of alcohol use.
- The medical comorbidity is related to individuals with past history of delirium.
- Future research with better methodology is required to draw definite conclusions.
| References|| |
|1.||Mannelli P, Pae CU. Medical comorbidity and alcohol dependence. Curr Psychiatry Rep 2007;9:217-24. |
|2.||Shore JH, Beals J, Orton H, Buchwald D. Comorbidity of alcohol abuse and dependence with medical conditions in 2 American Indian reservation communities Alcohol Clin Exp Res 2006;30:649-55. |
|3.||Rivas I, Sanvisens A, Bolao F, Fuster D, Tor J, Pujol R, et al. Impact of medical comorbidity and risk of death in 680 patients with alcohol use disorders. Alcohol Clin Exp Res 2013;37:221-7. |
|4.||Lindegard B, Hillbom M. Associations between brain infarction, diabetes and alcoholism: Observations from the Gothenburg population cohort study. Acta Neurol Scand 1987;75:195-200. |
|5.||Callahan CM, Tierney WM. Health services use and mortality among older primary care patients with alcoholism. J Am Geriatr Soc 1995;43:1378-83. |
|6.||Ueshima H, Shimamoto T, Iida M, Konishi M, Tanigaki M, Doi M, et al. Alcohol intake and hypertension among urban and rural Japanese populations. J Chronic Dis 1984;37:585-92. |
|7.||Beilin LJ. Epidemiology of alcohol and hypertension. Adv Alcohol Subst Abuse 1987;6:69-87. |
|8.||Beilin LJ, Puddey IB. Alcohol and hypertension. Hypertension 2006;47:1035-8. |
|9.||Saremi A, Hanson RL, Tulloch-Reid M, Williams DE, Knowler WC. Alcohol consumption predicts hypertension but not diabetes. J Stud Alcohol 2004;65:184-90. |
|10.||Cushman WC. Alcohol consumption and hypertension. J Clin Hypertens 2001;3:166-70. |
|11.||Parekh RS, Klag MJ. Alcohol: Role in the development of hypertension and end-stage renal disease. Curr Opin Nephrol Hypertens 2001;10:385-90. |
|12.||Denison H, Berkowicz A, Oden A, Wendestam C. The Significance of coronary death for the excess mortality in alcohol-dependent men. Alcohol Alcohol 1997;32:517-26. |
|13.||Thun M, Peto R, Lopez AD, Monaco JH, Henley J, Heath CW, et al. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med 1997;337:1705-14. |
|14.||O'Brien JM Jr, Lu B, Ali NA, Martin GS, Aberegg SK, Marsh CB, et al. Alcohol dependence is independently associated with sepsis, septic shock, and hospital mortality among adult intensive care unit patients. Crit Care Med 2007;35:345-50. |
|15.||Johnson KH, Bazargan M, Cherpitel CJ. Alcohol, tobacco, and drug use and the onset of type 2 diabetes among inner-city minority patients. J Am Board Fam Pract 2001;14:430-6. |
|16.||Lieber CS. Alcoholism: Medical complications. Ann N Y Acad Sci 1981;362:132-5. |
|17.||Ahmed AT, Karter AJ, Liu J. Alcohol consumption is inversely associated with adherence to diabetes self-care behaviours. Diabet Med 2006;23:795-802. |
|18.||Smith JW. Medical manifestations of alcoholism in the elderly. Int J Addict 1995;30:1749-98. |
|19.||Kahl KG, Greggersen W, Schweiger U, Cordes J, Correll CU, Ristow J, et al. Prevalence of the metabolic syndrome in men and women with alcohol dependence: Results from a cross-sectional study during behavioural treatment in a controlled environment. Addiction 2010;105:1921-7. |
|20.||Ballard HS. The hematological complications of alcoholism. Alcohol Health Res World 1997;21:42-52. |
|21.||Adams HG, Jordan C. Infections in the alcoholic. Med Clin North Am 1994;68:179-200. |
|22.||Cook RT. Alcohol Abuse, Alcoholism, and Damage to the Immune System-A Review. Alcohol Clin Exp Res 1998;22:1927-42. |
|23.||de Roux A, Cavalcanti M, Marcos MA, Garcia E, Ewig S, Mensa J, et al. Impact of alcohol abuse in the etiology and severity of community-acquired pneumonia. Chest 2006;129:1219-25. |
|24.||Dickey B, Normand SL, Weiss RD, Drake RE, Azeni H. Medical morbidity, mental illness, and substance use disorders. Psychiatr Serv 2002;53:861-7. |
|25.||Sodhi and Sharma. Socio economic status schedule. National Psychological Corporation, Agra, India 1986. |
[Table 1], [Table 2], [Table 3], [Table 4]