Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a prevalent condition with high morbidity and mortality, often accompanied by comorbidities such as alcohol use disorder (AUD). A thorough understanding of the interaction between COPD and AUD is crucial for improving patient outcomes and addressing management challenges. Objectives: This study analyzed temporal trends, clinical characteristics, and hospital outcomes associated with AUD among adults hospitalized with COPD in Spain between 2016 and 2023. Methods: A population-based cohort study was conducted using the Spanish Hospital Discharge Registry. We included adults aged ≥40 years with a diagnosis of COPD. AUD was identified through ICD-10 codes. Temporal trends in AUD prevalence were evaluated using Joinpoint regression, stratified by sex. We also assessed clinical characteristics including pneumonia, obesity, asthma, obstructive sleep apnea (OSA), supplemental oxygen use, long-term steroid use, and mechanical ventilation. Outcomes analyzed included ICU admission and in-hospital mortality (IHM). Results: Among 2,545,151 COPD hospitalizations, 263,568 (10.35%) had an AUD diagnosis. AUD prevalence rose from 8.66% in 2016 to 12.57% in 2023, with a sharper increase in women. Patients with AUD were younger and had higher rates of tobacco use (84.11% vs. 49.33%; p < 0.001) and psychiatric disorders. Multivariable analysis showed male sex, substance use, psychiatric illness, and external cause admissions were independently associated with AUD. Although overall IHM was lower in AUD patients (7.46% vs. 8.2%; p < 0.001), it increased with age, pneumonia, COVID-19, and higher comorbidity. IHM rose progressively, peaking in 2023 (15.6%). Conclusions: AUD prevalence in COPD hospitalizations increased significantly, especially in women. IHM also rose over time. These results highlight the need for integrated approaches targeting mental health and substance use in COPD management.