Prevalence of Alcohol Use Disorder and Alcohol-related Liver Disease in Women Undergoing Cervical Cancer Screening: A Missed Opportunity to Screen?

Abstract

Early recognition of alcohol use disorder (AUD) in women can reduce the risk of developing alcohol-related liver disease (ALD). For many women, reproductive health visits, including cervical cancer screening may be their only health care contact. We aimed to evaluate the prevalence of AUD and ALD in women undergoing cervical cancer screening and whether these visits represent missed opportunities for AUD identification. This is a retrospective analysis of adult women aged 21-65 who underwent cervical cancer screening in the nationwide MarketScan Database 7/1/2013-12/31/2021. ICD coding was used to identify inpatient/outpatient AUD/ALD diagnoses. Median time to AUD/ALD diagnosis was calculated, and the cumulative incidence of inpatient AUD/ALD following an initial outpatient encounter was estimated using the Kaplan-Meier method. A total of 11,429,720 women underwent cervical cancer screening (mean age 41.7 y). AUD was identified in approximately 1 in 50 women, one-quarter of whom required hospitalization. Notably, 30.7% of women hospitalized for AUD previously saw a provider for cervical cancer screening where AUD was not diagnosed. ALD was present in 0.1% (1 in 1,000) of women screened for cervical cancer, with about half requiring hospitalization. Among those hospitalized for ALD, 24.5% previously saw a provider for cervical cancer screening where AUD had not been identified. A notable proportion of women hospitalized for AUD/ALD had a prior cervical cancer screening visit where AUD was not identified, representing a missed opportunity for intervention. Standardized screening and referral for treatment at these visits may reduce downstream consequences of harmful alcohol use.