Age and Sex Differences in Alcohol Withdrawal Syndrome

To investigate alcohol withdrawal syndrome prevalence among women and to study age and sex differences in clinical manifestations and hospital course.

This cohort study included all hospitalized patients from June 1, 2019 to June 1, 2022, where the Clinical Institute Withdrawal Assessment for Alcohol Scale, revised, protocol for alcohol withdrawal syndrome was implemented.

A total of 16,190 hospitalizations (10,092 patients aged ≥21 years), with 30.2% women, were included in the study and divided into the following 4 age groups: 21 to 39 years (n=2453 [24.3%]), 40-64 years (n=5128 [50.8%]), 65-74 years (n=1705 [16.9%]), and 75 years or older (n=806 [8%]). We considered the age group (40-64 years) with the highest number of patients as the reference group. Older patients presented with lower blood alcohol concentration and took longer to reach peak withdrawal manifestations than younger patients. Compared with women, men in the youngest age group reached a peak withdrawal earlier (mean, 18.5 hours [95% CI, 17.2-19.8] vs 19.4 hours [95% CI, 17.5-21.3]; P<.001), and there was no sex difference in other age groups. Men required higher benzodiazepine doses during hospitalization in the youngest (mean, 20.1 mg [95% CI, 17.1-23.1] vs 13.6 mg [95% CI, 11.4-15.8]; P=.013) and the reference (mean, 18.0 mg [95% CI, 16.5-19.4] vs 12.7 mg [95% CI, 11.4-14]; P<.001) age groups; there was no sex difference among older adults. The benzodiazepine dose during the first 24 hours of hospitalization dose decreased significantly as age increased (21-39 years: mean, 6.64 mg [95% CI, 6.3-7.0]; 40-64 years: mean, 5.8 mg [95% CI, 5.5-6.0]; 65-74 years: mean, 3.76 mg [95% CI, 3.4-4.1]; ≥75 years: mean, 2.79 mg [95% CI, 2.4-3.2]; P<.001 for all groups). There was no sex difference in the all-cause mortality rate, including posthospitalization mortality, among any age group.

The results of this study show a narrowing of the traditional sex gap in alcohol withdrawal.