Impact of alcohol exclusion law repeal on inpatient alcohol-related diagnoses

Background Alcohol exclusion laws, which allow insurers to deny coverage for intoxication-related injuries, are a form of structural stigma that may discourage clinical documentation. We examined whether state alcohol exclusion law repeal was associated with changes in documented inpatient alcohol-related diagnoses. Methods Data were drawn from 132,917,864 adult inpatient discharge records from the Healthcare Cost and Utilization Project State Inpatient Databases (1999–2020). Outcomes were diagnoses of alcohol use disorder, alcohol intoxication, and laboratory evidence of alcohol in blood. Policy exposure was defined as the transition from alcohol exclusion law present status to repealed or prohibited status. We applied a two-stage difference-in-differences estimator to account for staggered policy adoption, adjusting for demographic and state-level covariates. Dynamic event-time estimates and robustness checks assessed temporal effects and identifying assumptions. Results Alcohol exclusion law repeal was not associated with a statistically significant overall change in inpatient alcohol use disorder diagnoses (ATT: 0.0021; 95% CI: −0.0065 to 0.0110). Event-study estimates indicated no significant association during the first nine years following repeal. Positive estimates observed in later post-repeal years were driven primarily by Rhode Island, whereas Colorado showed no detectable effect. Results were consistent across demographic subgroups and sensitivity analyses. In contrast to alcohol use disorder diagnoses, alcohol exclusion law repeal was associated with a modest reduction in intoxication diagnoses (ATT: −0.0035; 95% CI: −0.0050 to −0.0002), particularly within the first five years following repeal. No significant association was observed for diagnoses indicating alcohol in blood. Conclusion Repeal of alcohol exclusion laws was not associated with an increase in the documented prevalence of alcohol-related diagnoses among inpatient discharges. These findings do not support concerns that eliminating alcohol exclusion laws increases the documented prevalence of alcohol-related diagnoses in inpatient settings.