Prevalence of Alcohol Use Disorder Among Hospital Admissions with Type 2 Diabetes in Spain: Trends from 2016 to 2023 and Predictors of Hospitalization and In-Hospital Mortality

Background/Objectives: Alcohol consumption is a major public health concern, particularly among individuals with type 2 diabetes (T2D), due to its impact on morbidity and mortality. However, alcohol use disorder (AUD) among hospitalized T2D patients in Spain remains understudied. This study analyzed trends in AUD prevalence in adults hospitalized with T2D (2016–2023), identified associated factors, and assessed predictors of in-hospital mortality (IHM). Methods: We conducted a retrospective observational study using the Spanish National Hospital Discharge Database. Adults (≥18 years) with T2D were included. Joinpoint regression and multivariable logistic regression were applied. Results: Among 5,192,189 hospital admissions with T2D, 326,433 (6.29%) had AUD. Prevalence increased from 5.05% in 2016 to 7.52% in 2023 (annual percent change 5.95%; p < 0.05). AUD was more frequent in men (9.99%) than women (1.12%). Rising trends were observed for smoking (67.9% to 70.6%), cocaine use (2.0% to 3.15%), and cannabinoid use (1.08% to 1.78%) (all p < 0.001). Factors strongly associated with AUD included male sex (aOR 5.67; 95% CI 5.60–5.75), age 50–64 years, smoking (aOR 3.68 in men; 5.61 in women), cocaine use (aOR 4.55 in men; 7.68 in women), and mental disorders. IHM was 7.0% in T2D with AUD, peaking at 7.85% in 2020. Higher IHM was associated with age ≥ 80 years, hypoglycemia, and COVID-19, while obesity and mental disorders were linked to lower IHM. Conclusions: AUD prevalence in hospital admission with T2D in Spain is high and rising, particularly among women, with concomitant substance use also increasing. Comprehensive, sex-sensitive strategies are urgently needed in both hospital and outpatient care.