Setting of Alcohol Use Disorder Diagnosis Among Women Enrolled in Medicare

OBJECTIVE: The authors assessed the setting of an initial diagnosis of alcohol use disorder among Medicare-enrolled women. METHODS: Using 2016-2022 Medicare fee-for-service claims, the authors identified the first alcohol use disorder diagnosis for women ages 18-64 years (N=116,226) and ≥65 years (N=264,857) and examined the diagnosis setting. For diagnoses during a hospitalization, the authors determined how often alcohol use disorder was the principal diagnosis. RESULTS: About two-thirds of women ages 18-64 and ≥65 years received an initial diagnosis in a hospital or emergency department. Only 9%-14% of diagnoses were by primary care physicians and 2%-5% by behavioral health specialists in community-based practices. Alcohol use disorder was the principal diagnosis for ≤10% of hospitalizations in which a patient's condition was initially diagnosed, suggesting that it was often identified during acute treatment for other conditions. CONCLUSIONS: These results suggest the need for enhanced efforts to encourage early identification and management of alcohol use disorder outside acute care settings.