Alcohol Use Disorder Increases Risk of Traumatic Brain Injury-Related Hospitalization: Insights From 3.8 Million Children and Adolescent Inpatients

Objectives We conducted a cross-sectional study to identify the demographic predictors of traumatic brain injury (TBI), and the risk of association of psychiatric comorbidities including alcohol use disorder (AUD) and TBI-related hospitalizations in the children and adolescent population. Methods We included 3,825,523 children and adolescent inpatients (age 8-18 years) using the nationwide inpatient sample (NIS) database (2010-2014), and 61,948 inpatients had a primary diagnosis of TBI. These inpatients were grouped by comorbid AUD (N = 2,644). Multivariable logistic regression model adjusted for demographics, and psychiatric comorbidities including other substance use disorders (SUDs) was used to evaluate the odds ratio (OR) of AUD as a risk factor for TBI-related hospitalization. Results The majority of the TBI inpatients were adolescents (12-18 years, 82.2%), males (71.2%), and whites (59.2%). Males had three times higher odds (95% CI 3.14-3.26) for TBI-related hospitalization compared to females. Among psychiatric comorbidities, mood (4.1%) and anxiety (2.2%) disorders were prevalent in TBI inpatients, and were not associated with increased odds for TBI-related hospitalization. Among SUD, alcohol and tobacco use (4.4% each), and cannabis use (3.5%) were prevalent, and among all substances, AUD was associated with higher odds (OR 3.5, 95% CI 3.35-3.67) of TBI-related hospitalization. These patients with TBI and comorbid AUD also had higher odds for abusing stimulants (OR 5.11, 95% CI 3.85-6.77), cannabis (OR 4.69, 95% CI 4.12-5.34), and tobacco (OR 3.77, 95% CI 3.34-4.27). Conclusion AUD is an independent risk factor for TBI-related hospitalization with an increased risk of 50% in the children and adolescent population compared to non-alcohol users. TBI inpatients with AUD are prevalent in white, and male adolescents. These at-risk populations are also at higher risk of comorbid mood disorders and increased substance use including stimulants, cannabis, and tobacco.