Diagnostic Rates of Alcohol Use Disorder, Insomnia Disorder, and Their Co-Occurrence in the Veterans Health Administration From 2018 to 2023.

Abstract

We used data from the Veterans Health Administration (VA) to examine rates of alcohol use disorder (AUD), insomnia disorder, and their co-occurrence in a national sample of Veterans prior to and during the COVID-19 pandemic. We analyzed VA electronic health record data for Veterans using VA care between March 2018 and March 2023 (N = 5.6-5.8 million). We identified AUD and insomnia disorder using ICD-10 codes and calculated diagnosis rates for each year. Results were stratified by sex, age, race, and ethnicity. We first examined whether rates significantly changed over time via mixed-models. To understand magnitude of change across time, we then calculated the total relative change in diagnostic rates from 2018 to 2023. Approximately 5% of the sample had an AUD diagnosis, with rates staying relatively stable across years; around 6% to 8% of the sample had an insomnia disorder diagnosis, with rates increasing across years. The co-occurrence between AUD and insomnia disorder among the total sample ranged from 0.87% in 2018 to 2019 to 1.12% in 2022 to 2023. Among women Veterans, AUD diagnosis rates increased significantly across all racial and ethnic groups and for those aged 30 to 49 and 65+ years, while rates among men were mostly unchanged. Insomnia disorder diagnosis rates and their co-occurrence increased across all years for most men and women Veterans. Diagnosis rates increased for those most vulnerable to the negative health effects of AUD and insomnia (eg, women and older adults). Negative health outcomes could widen if access efforts do not take into account increasing diagnostic rates.