Mental and somatic multimorbidity among individuals with alcohol use disorder: A sex-stratified registry study.

Abstract

Alcohol use disorder (AUD) is a serious public health challenge associated with increased morbidity and mortality. While AUD is more common among males, the sex gap is narrowing; nevertheless, AUD remains underdiagnosed in females. Identifying sex-specific multimorbidity patterns could improve targeted screening and identification. Using the Norwegian Patient Registry, we identified 67,358 individuals with AUD (31.2% female) and age- and sex-matched controls. We compared sex differences in the prevalence of the 20 most common mental and somatic diagnoses within and between the AUD group and controls. We analysed multimorbidity using upset plots and correlation networks. Females with AUD had higher overall multimorbidity than males (median 9 [IQR: 5-14] vs. 6 [3-11] diagnoses). Asthma, eating disorders, and dementia were overrepresented among females with AUD. The most common diagnosis combinations in females with AUD involved overlaps between mental and somatic conditions, particularly other substance use disorders or depression combined with soft tissue disorders, urinary tract infections, or medical abortion. Males predominantly showed within-domain combinations. Correlation network analyses revealed a distinct pain-related cluster linking mental and somatic conditions in females with AUD, but not in control females. Females with AUD experience a disproportionately high level of multimorbidity, with distinct patterns, often involving combinations of somatic and mental diagnoses. Pain conditions serve as important links between mental and somatic comorbidity, especially for females. These findings support further investigation into sex-specific screening protocols, recognition of distinct clinical contact points, and integrated treatment approaches for AUD.