Alcohol consumption and illicit drug use: associations with fall, fracture, and acute healthcare utilization among people with HIV infection

Abstract

Background: Given alcohol and/or other drug (AOD) use occurs among people with HIV (PWH), we examined its association with falls and fall-related outcomes and if frailty moderates the association. Setting: Northeastern US city. Methods: We analyzed an observational cohort of PWH with current or past AOD use. Alcohol measures were any past 14-day heavy use, average alcohol/day, and days with heavy use. Drug use measures were past 30-day illicit use of cocaine, opioids, and sedatives. Repeated cross-sectional associations were estimated with separate multivariable GEE regression models for each fall-related outcome. Results: Among PWH (n=251; mean age 52 [standard deviation=10]), 35% reported heavy alcohol use, 24% cocaine, 16% illicit opioids, 13% illicit sedatives, 35% any fall; 27% were frail. Heavy alcohol use was associated with a fall (AOR=1.49, 95%CI: 1.08, 2.07), multiple falls (AOR=1.55 95%CI: 1.10, 2.19), and fall/fracture-related emergency department (ED) visit or hospitalization (AOR=1.81, 95%CI: 1.10, 2.97). Higher average alcohol/day and more heavy drinking days were associated with multiple falls. Illicit sedative use was associated with a fall, multiple falls, and ED/hospitalization and opioid use with fracture. Frailty moderated the association of heavy alcohol use and a fall (AOR=2.26, 95%CI 1.28, 4.01 in those frail) but not in those not frail. Conclusion: The effect of AOD use on falls and fall-related outcomes was most pronounced with alcohol, particularly among frail PWH. Heavy alcohol, illicit sedative, and illicit opioid use are high-priority targets for preventing falls and fall-related consequences for PWH.