Learning Objectives: To determine the impact of nicotine dependence on alcohol-related hospital discharges
Abstract:
Problem/Objective: Tobacco use causes higher rates of morbidity and mortality in the US than all other dependence-producing substances. Understanding the complex interaction between tobacco and alcohol, and its effect on co-morbidity has been limited. Such information is particularly lacking for hospitalized African-American patients.
Method: Demographic and clinical information on all alcohol abuse/dependent hospitalized discharges (N=6714) between 1995-2000 was extracted from the Johns Hopkins Hospital's computerized database. Tobacco and alcohol abuse/dependence diagnoses (with no other drug abuse/dependence) were identified by recorded ICD-9-CM diagnostic codes.
Results: This retrospective cohort study will examine the complex interaction of tobacco and alcohol abuse on comorbidity, mortality, length of stay, hospital costs, and payor group. African-American inpatients with tobacco and alcohol abuse were older and more likely to be non-emergency hospital admissions when compared to nonsmoking cohorts who abused alcohol only. No differences were found in gender or marital status. The Departments of Medicine, Surgery and Psychiatry had the highest number of tobacco-dependent discharges; however, they had the lowest proportion of tobacco-dependent discharges when compared to other clinical departments (p<.01). A low rate of tobacco discharges reported by the Department of Psychiatry was unexpected since this department is typically responsible for screening and treating tobacco-dependent individuals.
Conclusions: All hospitalized patients should be screened and treated for tobacco use to reduce tobacco-related morbidity and mortality. The importance of screening is particularly underscored in hospitalized African Americans with high rates of morbidity and mortality.
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