Servicio de Medicina Interna, Hospital Universitario de Canarias, Tenerife, Canary Islands, Spain
Received 17 August 2000; in revised form 20 December 2000; accepted 9 February 2001
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ABSTRACT |
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INTRODUCTION |
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PATIENTS AND METHODS |
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RESULTS |
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Twenty-three heavy drinkers (9.31%) died during hospitalisation, six of them women (i.e. 26.1% of all women; 7.6% of alcoholic men). Nine patients died from complications of liver cirrhosis, three more with superimposed hepatocarcinoma, six because of septic shock (in one case with alcoholic cardiomyopathy, and in a second case with severe chronic pancreatitis), one due to acute necrotizing pancreatitis, four with neoplasia other than hepatocarcinoma (lung, two cases; oesophagus, one case, unknown origin). A similar mortality (10.2%) was observed among the non-alcoholic patients during the same period: 144 non-alcoholic men (10.1%) and 124 (10.2%) non-alcoholic women died. The mean age of the non-alcoholic men who died was 76.3 ± 14.1 years, whereas that of the women was 80.9 ± 11.6 years. The mean age of men with heavy alcohol consumption who died was 56.9 ± 13.7 years. In 12 cases, the age at death was less than 65 years, with a total loss of 168 (14 ± 11, mean ± SD) productive years of life. The mean age of the heavy alcohol-consuming women who died was 58.8 ± 10.4 years; in four cases, the age at death was less than 65 years, with a loss of 39 (9.75 ± 7.7) productive years of life. In both men and women, the age at death was highly significantly lower than that of non-alcoholic men and women (P < 0.0001 in both cases). Crude mortality and mortality rates in the different age groups are given in Table 2, whereas Table 3
shows the differences between heavy consumers who died and those who survived.
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DISCUSSION |
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In Spain, chronic alcohol consumption is associated with enormous health costs (Portella et al., 1998). In Spanish hospitals, the prevalence of alcoholism is higher than 20% (Palazón-Azorín et al., 1988
) or even 30% (Cirera-Costa et al., 1985
; Humbert et al., 1987
), although some have reported higher values (Rodríguez and Cami, 1988
).
As in most studies, there is a higher prevalence of heavy consumption in hospitalized men than in women. It is noteworthy that cirrhosis has a higher prevalence among women. Perhaps this result relates to the enhanced susceptibility of the female liver to alcohol-induced damage (Morgan and Sherlock, 1977), but it may also be true that women do not see themselves as heavy drinkers until the clinical evidence is overwhelming. It is important to consider our results regarding mortality. In our study, mortality of the alcoholic group was only slightly lower than that of the non-alcoholic group, despite an enormous difference in age at death. The results were more striking among women, in whom mortality was higher in the alcoholic group, despite a 22-year difference in age. Other authors have also pointed out the impact of alcoholism on mortality. Alcohol intake exceeding 30 g/day was associated with a mortality 3.4 times greater for women and 3 times greater for men (Andreasson and Brandt, 1997
) and the life span of alcoholic women is shortened by more than 15 years (Smith et al., 1983
), a result which emphasizes the increased susceptibility of women to alcohol-induced damage. However, other authors (Wallerstedt et al., 1995
; Saitz et al., 1997
) have failed to find an association between alcoholism and excess mortality, although it increases morbidity and hospital admissions (Andreasson et al., 1990
; Piette et al., 1998
). These observations are fully in accord with the fact that the alcoholics in this study were 1115 years younger than the non-alcoholics, and with the findings of a higher rate of complications in orthopaedic alcoholic in-patients (Tonnesen et al., 1991
) and a greater difficulty in nursing patients (Poon et al., 1994
). Also, chronic alcohol misuse but not acute is associated with greater morbidity after trauma (Jukovich et al., 1993
) and increased peri-operative complications are also observed in neurosurgery (Sonne and Tonnesen, 1992
) and colorectal surgery (Tonnesen et al., 1992
).
Thus, in our geographical location, heavy alcohol consumption is responsible for approximately 10% of hospital admissions to a general medical unit of a tertiary hospital. These admissions occur about 1015 years earlier than in the non-alcoholic population, and the mortality rate attributable to heavy drinking is similar to that of the non-alcoholic population who are 20 years older. Some preventive measures could drastically reduce these figures. Indeed, it has been shown that alcohol-related admissions to a hospital are related to the density of alcohol outlets (Tatlow et al., 2000) and that alcohol sales affect the rate of cirrhosis and mortality (Leifman and Romelsjo, 1997
). Thus, social and political measures are urgently needed to limit production and marketing of alcoholic beverages.
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FOOTNOTES |
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