Sex-Specific Comorbidity Patterns and In-Hospital Mortality Among Patients With Alcohol-Related Diseases in South Korea

OBJECTIVES: Understanding comorbidities in alcohol-related diseases (ARD) is crucial for predicting outcomes and assessing care quality. This study characterized comorbidity patterns and sex-specific mortality risk among ARD patients using nationally representative hospital discharge data. METHODS: Using data from the Korean National Hospital Discharge In-depth Injury Survey (2007-2022), patients with ARD (E24.4, F10, G31.2, G62.1, G72.1, I42.6, K29.2, K70, K85.2, K86.0, R78.0) as the primary diagnosis were included. Up to 20 secondary diagnoses were defined as comorbidities. Association rule mining was applied to identify comorbidity patterns, followed by complex-sample logistic regression to estimate in-hospital mortality risk associated with identified comorbidity patterns. RESULTS: A total of 46,225 cases were reported in 2007, showing fluctuation but an overall decline after 2016, with sharp decreases in 2020-2021 and a slight rebound in 2022 (p < .05). Males were mostly in their 50s and females in their 40s, both commonly treated in 100-299-bed hospitals under National Health Insurance. Alcoholic liver disease (K70) was the most frequent primary diagnosis in both sexes, most commonly co-occurring with circulatory disorders (I98), type 2 diabetes (E11), and essential hypertension (I10), with the strongest co-occurrence observed between K70 and I98 (males: 13.2%; females: 11.2%). Among patients with K70 as the primary diagnosis, hepatic failure (K72) was the strongest comorbid predictor of in-hospital mortality in both sexes, with a markedly greater effect in females (aOR = 6.464, 95% CI 3.930-10.633) than in males (aOR = 4.284, 95% CI 3.414-5.376). Co-occurring alcohol use disorder (F10) was associated with reduced mortality risk in both sexes (males: aOR = 0.556, 95% CI 0.400-0.773; females: aOR = 0.326, 95% CI 0.115-0.923). CONCLUSIONS: Despite declining trends in ARD discharges, female patients showed more severe clinical profiles, highlighting the need for sex-specific interventions. Comprehensive monitoring and sex-stratified management are essential to address the systemic impact of ARD and the higher mortality risk observed among female patients.