Cause-specific mortality risk in alcohol use disorder treatment patients: a systematic review and meta-analysis

Background: Alcohol use disorders (AUD) are highly disabling. Recent studies reported much higher relative risks for all-cause mortality in AUD patients compared with earlier studies. Systematic evidence regarding cause-specific mortality among AUD patients has been unavailable to date. Methods: Studies were identified through MEDLINE, EMBASE and Web of Science up to August 2012. Following MOOSE guidelines, prospective and historical cohort studies assessing cause-specific mortality risk from AUD patients at baseline compared with the general population were selected. Data on several study characteristics, including AUD assessment, follow-up period, setting, location and cause-specific mortality risk compared with the general population were abstracted. Random-effect meta-analyses were conducted. Results: Overall, 17 observational studies with 6420 observed deaths among 28 087 AUD patients were included. Pooled standardized mortality ratios (SMRs) after 10 years of follow-up among men were 14.8 (95% confidence interval: 8.7-24.9) for liver cirrhosis, 18.0 (11.2-30.3) for mental disorders, 6.6 (5.0-8.8) for death by injury and around 2 for cancer and cardiovascular diseases. SMRs were substantially higher in women, with fewer studies available. For many outcomes the risk has been increasing substantially over time. Conclusions: Cause-specific mortality among AUD patients was high in all major categories compared with the general population. There has been a lack of recent research, and future studies should focus on the influence of comorbidities on excess mortality risk among AUD patients. Efforts to reduce these risks should be a priority, given that successful treatment reduces mortality risk substantially for a relatively common psychiatric disease.