{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:47:46Z","timestamp":1786978066661,"version":"build-2736575974"},"reference-count":20,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T00:00:00Z","timestamp":1733097600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["shmpublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Hospital Medicine"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Alcohol use disorder (AUD) is a leading cause of morbidity and mortality that disproportionately affects rural residents and Veterans.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the burden of AUD in admissions at rural and urban hospitals within the Veterans Health Administration (VHA) comparing patient characteristics, clinical outcomes, and 1\u2010, 3\u2010, and 5\u2010year mortality rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective cross\u2010sectional study of patients admitted to VHA hospitals from 2016 to 2020, with a primary or secondary diagnosis related to AUD. Follow\u2010up mortality data was collected through September 30, 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      From 2.9 million qualifying admissions, AUD\u2010related diagnoses were present in 14.3% of admitted patients (427,375 admissions among 190,152 unique patients in 129 facilities). Rural hospitals (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200922) had a significantly higher overall admission rate for AUD\u2010related diagnoses (21.6% vs. 14.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.011), higher 30\u2010day readmission rates (17.8% vs. 15.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001), but lower hospital\u2010level average length of stay (median\u2009=\u20094.3 vs. 5.6,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001). Mortality in rural hospitals was lower than urban at 1 year (9.6% vs. 11.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001), 3 years (20.7% vs. 23.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001), and 5 years (30.4% vs. 32.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Rural VHA hospitals have a higher proportion of patients admitted with AUD\u2010related diagnoses and higher readmission rates, but lower mortality rates. Approximately, one in three patients admitted with an AUD\u2010related diagnosis died within the 5\u2010year follow\u2010up period. The mortality rates observed are extraordinary and deserve urgent attention. A comprehensive plan to address AUD in the Veteran population, including how we approach and engage patients in treatment during hospitalizations with any primary or secondary AUD diagnoses, is needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jhm.13544","type":"journal-article","created":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T23:34:58Z","timestamp":1733182498000},"page":"463-470","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Impact of alcohol use disorder on inpatient hospitalizations: A comparison of outcomes between urban and rural Veterans Affairs hospitals"],"prefix":"10.1002","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9470-8506","authenticated-orcid":false,"given":"James","family":"Willey","sequence":"first","affiliation":[{"name":"Comprehensive Access and Delivery Research and Evaluation (CADRE) Center Iowa City VA Healthcare System Iowa City Iowa USA"},{"name":"VA Office of Rural Health, Veterans Rural Health Resource Center \u2010 Iowa City (VRHRC\u2010IC) Iowa City Veterans Affairs Health Care System Iowa City Iowa USA"},{"name":"Department of Internal Medicine University of Iowa Iowa City Iowa USA"},{"name":"Department of Internal Medicine University of Utah Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kaboli","sequence":"additional","affiliation":[{"name":"Comprehensive Access and Delivery Research and Evaluation (CADRE) Center Iowa City VA Healthcare System Iowa City Iowa USA"},{"name":"VA Office of Rural Health, Veterans Rural Health Resource Center \u2010 Iowa City (VRHRC\u2010IC) Iowa City Veterans Affairs Health Care System Iowa City Iowa USA"},{"name":"Department of Internal Medicine University of Iowa Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Holcombe","sequence":"additional","affiliation":[{"name":"Comprehensive Access and Delivery Research and Evaluation (CADRE) Center Iowa City VA Healthcare System Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy M. J.","family":"O'Shea","sequence":"additional","affiliation":[{"name":"Comprehensive Access and Delivery Research and Evaluation (CADRE) Center Iowa City VA Healthcare System Iowa City Iowa USA"},{"name":"VA Office of Rural Health, Veterans Rural Health Resource Center \u2010 Iowa City (VRHRC\u2010IC) Iowa City Veterans Affairs Health Care System Iowa City Iowa USA"},{"name":"Department of Internal Medicine University of Iowa Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tong","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Iowa Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelby","family":"Rewerts","sequence":"additional","affiliation":[{"name":"Comprehensive Access and Delivery Research and Evaluation (CADRE) Center Iowa City VA Healthcare System Iowa City Iowa USA"},{"name":"VA Office of Rural Health, Veterans Rural Health Resource Center \u2010 Iowa City (VRHRC\u2010IC) Iowa City Veterans Affairs Health Care System Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Bailey","sequence":"additional","affiliation":[{"name":"Comprehensive Access and Delivery Research and Evaluation (CADRE) Center Iowa City VA Healthcare System Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anindita","family":"Bandyopadhyay","sequence":"additional","affiliation":[{"name":"Comprehensive Access and Delivery Research and Evaluation (CADRE) Center Iowa City VA Healthcare System Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thad","family":"Abrams","sequence":"additional","affiliation":[{"name":"Comprehensive Access and Delivery Research and Evaluation (CADRE) Center Iowa City VA Healthcare System Iowa City Iowa USA"},{"name":"VA Office of Rural Health, Veterans Rural Health Resource Center \u2010 Iowa City (VRHRC\u2010IC) Iowa City Veterans Affairs Health Care System Iowa City Iowa USA"},{"name":"Department of Internal Medicine University of Iowa Iowa City Iowa USA"},{"name":"Department of Psychiatry University of Iowa Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7596-1779","authenticated-orcid":false,"given":"Jeydith T.","family":"Gutierrez","sequence":"additional","affiliation":[{"name":"Comprehensive Access and Delivery Research and Evaluation (CADRE) Center Iowa City VA Healthcare System Iowa City Iowa USA"},{"name":"VA Office of Rural Health, Veterans Rural Health Resource Center \u2010 Iowa City (VRHRC\u2010IC) Iowa City Veterans Affairs Health Care System Iowa City Iowa USA"},{"name":"Department of Internal Medicine University of Iowa Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,12,2]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"National Institute on Alcohol Abuse and Alcoholism. 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