title: The impact of alcohol-related diagnoses on pneumonia outcomes.
abstract: BACKGROUND
  There is controversy regarding the role of alcoholism as a prognostic factor in hospitalized patients with pneumonia.
  
  
  OBJECTIVE
  To assess the impact of alcohol abuse on hospitalization charges, length of hospital stay, intensive care unit use, and in-hospital mortality.
  
  
  METHODS
  We studied a cohort of all adults hospitalized in 1992 in Massachusetts with a principal diagnosis of pneumonia, and all Massachusetts residents hospitalized for pneumonia in 6 bordering states.
  
  
  RESULTS
  For the 23,198 pneumonia cases the mean total hospitalization charges were $9925, mean length of hospital stay was 9.6 days, 12% of the cases had intensive care unit stays, and 10% of the cases died during the hospitalization. In bivariate analyses, pneumonia cases with alcohol-related diagnoses had higher charges (mean, $11,232 vs $9877, P = .07), had shorter length of hospital stay (9.2 vs 9.6 days, P = .02), were more likely to experience an intensive care unit stay (19% vs 12%, P < .001), and had lower in-hospital mortality (6.0% vs 10.2%, P < .001). Multivariable analyses adjusting for comorbidity, pneumonia etiology, and demographics revealed that for pneumonia cases with alcohol-related diagnoses, risk-adjusted hospital charges were $1293 higher (adjusted mean, $11,179 vs $9888, P < .001), length of hospital stay was 0.6 days longer (10.1 vs 9.5 days, P = .001), intensive care unit use was higher (18% vs 12%; adjusted odds ratio, 1.63; 95% confidence interval, 1.33-1.98), and mortality was no different (10% with or without an alcohol-related diagnosis).
  
  
  CONCLUSIONS
  Having an alcohol-related diagnosis is associated with more use of intensive care, longer inpatient stays, and higher hospital charges. To understand resource utilization in cases of pneumonia, alcohol abuse is a comorbid factor that must be considered.
authors.affiliation: Research Unit, Boston Medical Center, Boston University School of Medicine, Mass, USA.
authors.forename: R
authors.initials: R
authors.lastname: Saitz
authors.forename: W A
authors.initials: WA
authors.lastname: Ghali
authors.forename: M A
authors.initials: MA
authors.lastname: Moskowitz
mesh_terms: D000368:Aged; D000437:Alcoholism / Q000150:complications* / Q000191:economics / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D017722:Hospital Charges; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008404:Massachusetts; D011014:Pneumonia / Q000191:economics / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome