Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://www.gastrores.org

Original Article

Volume 15, Number 4, August 2022, pages 207-216

Trends of Alcohol Withdrawal Delirium in the Last Decade: Analysis of the Nationwide Inpatient Sample

Figure 1. Trends in the adjusted incidence of alcohol withdrawal delirium among all hospitalizations from 2010 to 2019. *Statistically significant. APC = 3.1%, CI: 2.2 - 4.0, P < 0.001. APC: annual percentage change; AWD: alcohol withdrawal delirium.

Figure 2. Trends in adjusted alcohol withdrawal delirium admission rate from 2010 to 2019. *Statistically significant. (2010 - 2012) APC = 3.3%, CI: 5.9 - 13.4, P = 0.271; (2012 - 2015) APC = 9.8%, CI: 4.3 - 15.7, P = 0.016; (2015 - 2019) APC = 2.2%, CI: 0.2 - 4.3, P = 0.041; (2010 - 2019) average APC = 5.0%, CI: 3.6 - 6.3, P < 0.001. APC: annual percentage change; AWD: alcohol withdrawal delirium; CI: CI: confidence interval.

**Table 1.** Demographics of All Hospitalizations Complicated by Alcohol Withdrawal Delirium (AWD)
Year	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	P value
CCI: Charlson comorbidity index; SD: standard deviation.
Total hospitalizations (million)	31.4	31.5	30.7	30	29.8	30.2	30.2	30.4	30.3	30.2
Hospitalizations complicated by AWD	83,893	84,819	87,330	87,265	91,055	100,160	101,365	102,570	102,855	102,850
Incidence of AWD per million hospitalizations	2,671.8	2,692.7	2,844.6	2,908.8	3,055.5	3,316.6	3,356.5	3,374	3,394.6	3,405.6
Mean age (years) ± SD	52.4 ± 12.5	52.5 ± 12.8	52.4 ± 12.5	52.5 ± 12.5	52.5 ± 12.6	52.5 ± 12.5	52.5 ± 12.8	52.6 ± 12.9	52.4 ± 13.0	52.1 ± 13.1	0.183
Age categories (%)											< 0.001
Young adult	24.6	24.1	24.8	24.8	25.3	25.6	26.3	26.7	27.7	29.5
Middle aged	59.0	59.5	58.4	58.6	58.0	58.0	56.9	55.7	54.9	53.1
Elderly	16.5	16.4	16.7	16.7	16.6	16.3	16.8	17.7	17.4	17.4
Female (%)	18.7	20.2	19.7	19.7	20.1	20.2	19.9	19.8	20.5	20.7	0.014
Race (%)											< 0.001
White	66.6	69.2	72.3	72.9	72.9	72.0	72.9	73.2	73.6	73.8
Black	10.6	9.2	10.1	9.5	9.4	10.2	9.9	10.0	9.5	9.4
Hispanic	8.3	7.9	8.3	8.5	8.2	8.6	8.6	9.3	9.8	9.7
Other	14.5	13.7	9.4	9.1	9.5	9.2	8.6	7.5	7.0	7.1
Median household income for zip code (%)											0.093
Low income	31.2	30.1	32.2	30.0	31.5	33.4	32.4	31.7	29.9	31.1
Middle income	25.9	25.1	24.7	26.5	27.4	23.9	24.8	26.1	26.1	25.5
Upper middle income	22.6	24.1	23.9	24.3	22.9	23.6	23.4	23.9	25.1	24.8
High income	20.3	20.7	19.3	19.3	18.3	19.2	19.4	18.4	18.9	18.7
CCI (%)											< 0.001
0	49.8	47.7	47.6	48.2	47.6	47.0	33.2	32.6	32.1	31.7
1	24.0	24.2	24.8	23.9	24.3	24.3	31.3	31.4	31.7	32.1
2	9.6	9.8	10.0	10.1	10.0	10.4	14.1	13.9	13.9	14.0
≥ 3	16.6	18.3	17.6	17.8	18.1	18.3	21.4	22.1	22.3	22.3
Primary payer (%)											< 0.001
Medicare	28.2	29.0	29.7	29.7	28.5	28.0	27.8	27.4	26.5
Medicaid	21.2	22.0	22.4	23.2	32.0	34.2	36.0	36.9	37.8
Private insurance	26.7	26.0	24.6	25.1	24.1	24.6	24.0	22.9	22.8
Self-pay	23.8	23.0	23.3	22.0	15.4	13.1	12.3	12.8	12.9

Table 1. Demographics of All Hospitalizations Complicated by Alcohol Withdrawal Delirium (AWD)

Year

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

P value

CCI: Charlson comorbidity index; SD: standard deviation.

Total hospitalizations (million)

31.4

31.5

30.7

29.8

30.2

30.4

30.3

30.2

Hospitalizations complicated by AWD

83,893

84,819

87,330

87,265

91,055

100,160

101,365

102,570

102,855

102,850

Incidence of AWD per million hospitalizations

2,671.8

2,692.7

2,844.6

2,908.8

3,055.5

3,316.6

3,356.5

3,374

3,394.6

3,405.6

Mean age (years) ± SD

52.4 ± 12.5

52.5 ± 12.8

52.4 ± 12.5

52.5 ± 12.5

52.5 ± 12.6

52.5 ± 12.5

52.5 ± 12.8

52.6 ± 12.9

52.4 ± 13.0

52.1 ± 13.1

0.183

Age categories (%)

< 0.001

Young adult

24.6

24.1

24.8

25.3

25.6

26.3

26.7

27.7

29.5

Middle aged

59.0

59.5

58.4

58.6

58.0

56.9

55.7

54.9

53.1

Elderly

16.5

16.4

16.7

16.6

16.3

16.8

17.7

17.4

Female (%)

18.7

20.2

19.7

20.1

20.2

19.9

19.8

20.5

20.7

0.014

Race (%)

< 0.001

White

66.6

69.2

72.3

72.9

72.0

72.9

73.2

73.6

73.8

Black

10.6

9.2

10.1

9.5

9.4

10.2

9.9

10.0

9.5

9.4

Hispanic

8.3

7.9

8.3

8.5

8.2

8.6

9.3

9.8

9.7

Other

14.5

13.7

9.4

9.1

9.5

9.2

8.6

7.5

7.0

7.1

Median household income for zip code (%)

0.093

Low income

31.2

30.1

32.2

30.0

31.5

33.4

32.4

31.7

29.9

31.1

Middle income

25.9

25.1

24.7

26.5

27.4

23.9

24.8

26.1

25.5

Upper middle income

22.6

24.1

23.9

24.3

22.9

23.6

23.4

23.9

25.1

24.8

High income

20.3

20.7

19.3

18.3

19.2

19.4

18.4

18.9

18.7

CCI (%)

< 0.001

49.8

47.7

47.6

48.2

47.6

47.0

33.2

32.6

32.1

31.7

24.0

24.2

24.8

23.9

24.3

31.3

31.4

31.7

32.1

9.6

9.8

10.0

10.1

10.0

10.4

14.1

13.9

14.0

≥ 3

16.6

18.3

17.6

17.8

18.1

18.3

21.4

22.1

22.3

Primary payer (%)

< 0.001

Medicare

28.2

29.0

29.7

28.5

28.0

27.8

27.4

26.5

Medicaid

21.2

22.0

22.4

23.2

32.0

34.2

36.0

36.9

37.8

Private insurance

26.7

26.0

24.6

25.1

24.1

24.6

24.0

22.9

22.8

Self-pay

23.8

23.0

23.3

22.0

15.4

13.1

12.3

12.8

12.9

**Table 2.** Outcomes of All Hospitalizations Complicated by Alcohol Withdrawal Delirium
	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	P trend
THC: total hospital charges; LOS: length of stay.
Mortality (%)	2.4	2.4	2.4	2.6	2.3	2.5	2.6	2.8	2.5	2.4	0.044
THC ($)	71,101	74,031	74,547	77,006	80,545	83,273	88,224	89,806	89,892	91,642	< 0.001
LOS (days)	8.5	8.4	8.5	8.4	8.6	8.6	8.8	8.7	8.6	8.5	0.006

Table 2. Outcomes of All Hospitalizations Complicated by Alcohol Withdrawal Delirium

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

P trend

THC: total hospital charges; LOS: length of stay.

Mortality (%)

2.4

2.6

2.3

2.5

2.6

2.8

2.5

2.4

0.044

THC ($)

71,101

74,031

74,547

77,006

80,545

83,273

88,224

89,806

89,892

91,642

< 0.001

LOS (days)

8.5

8.4

8.5

8.4

8.6

8.8

8.7

8.6

8.5

0.006

**Table 3.** Demographics of Hospitalizations With Alcohol Withdrawal Delirium (AWD) as the Principal Diagnosis
Year	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	P value
CCI: Charlson comorbidity index; SD: standard deviation.
Hospitalization with AWD as principal diagnosis	32,352	31,691	34,130	35,250	38,460	43,970	44,950	44,945	46,100	46,990
AWD admission rate per million hospitalizations	1,030.3	1,006.1	1,111.7	1,175	1,290.6	1,456	1,488.4	1,478.5	1,521.5	1,556
Mean age (years) ± SD	48.9 ± 11.3	49.1 ± 11.7	49.0 ± 11.6	49.1 ± 11.6	49.1 ± 11.7	49.4 ± 11.9	49.1 ± 12.1	49.3 ± 12.2	49.2 ± 12.4	48.9 ± 12.4	0.439
Age categories (%)											< 0.001
Young adult	32.8	32.2	33.2	33.2	33.6	33.6	34.7	35.2	35.6	37.5
Middle aged	58.6	59.1	57.7	58.0	57.4	56.8	55.8	54.2	53.7	52.2
Elderly	8.6	8.7	9.1	8.8	9.0	9.6	9.6	10.6	10.7	10.3
Female (%)	18.4	20.4	19.3	19.3	20.2	19.8	19.0	19.2	19.4	20.0	0.231
Race (%)											< 0.001
White	66.3	69.0	71.9	73.3	72.3	71.4	71.9	72.5	72.6	72.7
Black	9.6	8.3	8.9	8.0	8.2	8.9	9.2	8.8	8.6	8.6
Hispanic	10.3	9.4	9.8	9.5	9.4	9.9	10.2	11.1	11.4	11.4
Other	13.8	13.3	9.5	9.2	10.1	9.8	8.7	7.6	7.3	7.4
Median household income for zip code (%)											0.031
Low income	30.1	27.0	30.3	27.8	29.3	31.2	30.0	29.1	26.6	29.1
Middle income	24.4	23.6	23.4	26.1	26.3	23.0	24.5	25.1	26.1	24.6
Upper middle income	23.4	25.6	24.6	24.9	24.0	24.1	24.6	24.8	26.4	26.0
High income	22.1	23.8	21.7	21.3	20.4	21.8	21.0	21.0	20.9	20.3
CCI (%)											< 0.001
0	66.9	66.4	64.0	64.7	64.8	59.4	44.1	43.8	42.2	41.7
1	20.8	21.0	23.1	21.0	21.0	24.8	35.0	35.3	35.3	36.1
2	5.5	5.3	5.6	6.3	6.0	7.1	10.5	10.2	11.4	11.2
≥ 3	6.7	7.3	7.3	8.1	8.3	8.7	10.4	10.8	11.1	11.1
Primary payer (%)											< 0.001
Medicare	19.0	20.6	20.4	20.8	20.9	20.7	20.1	20.0	19.7	18.7
Medicaid	21.9	22.2	23.3	24.5	35.3	38.1	40.3	41.3	41.5	42.2
Private insurance	27.3	27.4	25.9	26.9	24.6	25.4	24.4	24.4	23.2	23.8
Self-pay	31.8	39.9	30.4	27.8	19.2	15.8	15.2	14.3	15.6	15.3

Table 3. Demographics of Hospitalizations With Alcohol Withdrawal Delirium (AWD) as the Principal Diagnosis

Year

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

P value

CCI: Charlson comorbidity index; SD: standard deviation.

Hospitalization with AWD as principal diagnosis

32,352

31,691

34,130

35,250

38,460

43,970

44,950

44,945

46,100

46,990

AWD admission rate per million hospitalizations

1,030.3

1,006.1

1,111.7

1,175

1,290.6

1,456

1,488.4

1,478.5

1,521.5

1,556

Mean age (years) ± SD

48.9 ± 11.3

49.1 ± 11.7

49.0 ± 11.6

49.1 ± 11.6

49.1 ± 11.7

49.4 ± 11.9

49.1 ± 12.1

49.3 ± 12.2

49.2 ± 12.4

48.9 ± 12.4

0.439

Age categories (%)

< 0.001

Young adult

32.8

32.2

33.2

33.6

34.7

35.2

35.6

37.5

Middle aged

58.6

59.1

57.7

58.0

57.4

56.8

55.8

54.2

53.7

52.2

Elderly

8.6

8.7

9.1

8.8

9.0

9.6

10.6

10.7

10.3

Female (%)

18.4

20.4

19.3

20.2

19.8

19.0

19.2

19.4

20.0

0.231

Race (%)

< 0.001

White

66.3

69.0

71.9

73.3

72.3

71.4

71.9

72.5

72.6

72.7

Black

9.6

8.3

8.9

8.0

8.2

8.9

9.2

8.8

8.6

Hispanic

10.3

9.4

9.8

9.5

9.4

9.9

10.2

11.1

11.4

Other

13.8

13.3

9.5

9.2

10.1

9.8

8.7

7.6

7.3

7.4

Median household income for zip code (%)

0.031

Low income

30.1

27.0

30.3

27.8

29.3

31.2

30.0

29.1

26.6

29.1

Middle income

24.4

23.6

23.4

26.1

26.3

23.0

24.5

25.1

26.1

24.6

Upper middle income

23.4

25.6

24.6

24.9

24.0

24.1

24.6

24.8

26.4

26.0

High income

22.1

23.8

21.7

21.3

20.4

21.8

21.0

20.9

20.3

CCI (%)

< 0.001

66.9

66.4

64.0

64.7

64.8

59.4

44.1

43.8

42.2

41.7

20.8

21.0

23.1

21.0

24.8

35.0

35.3

36.1

5.5

5.3

5.6

6.3

6.0

7.1

10.5

10.2

11.4

11.2

≥ 3

6.7

7.3

8.1

8.3

8.7

10.4

10.8

11.1

Primary payer (%)

< 0.001

Medicare

19.0

20.6

20.4

20.8

20.9

20.7

20.1

20.0

19.7

18.7

Medicaid

21.9

22.2

23.3

24.5

35.3

38.1

40.3

41.3

41.5

42.2

Private insurance

27.3

27.4

25.9

26.9

24.6

25.4

24.4

23.2

23.8

Self-pay

31.8

39.9

30.4

27.8

19.2

15.8

15.2

14.3

15.6

15.3

**Table 4.** Outcomes of Hospitalizations With Alcohol Withdrawal Delirium as the Principal Diagnosis
	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	P trend
THC: total hospital charges; LOS: length of stay.
Mortality (%)	0.5	0.5	0.4	0.5	0.4	0.5	0.5	0.4	0.4	0.5	0.797
THC ($)	37,093	38,306	39,497	41,185	44,005	46,293	48,059	49,546	51,075	51,543	< 0.001
LOS (days)	5.8	5.8	5.8	5.9	6.1	6.1	6.2	6.2	6.2	6.0	< 0.001

Table 4. Outcomes of Hospitalizations With Alcohol Withdrawal Delirium as the Principal Diagnosis

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

P trend

THC: total hospital charges; LOS: length of stay.

Mortality (%)

0.5

0.4

0.5

0.4

0.5

0.4

0.5

0.797

THC ($)

37,093

38,306

39,497

41,185

44,005

46,293

48,059

49,546

51,075

51,543

< 0.001

LOS (days)

5.8

5.9

6.1

6.2

6.0

< 0.001