Alcohol use disorders are associated with higher healthcare expenditure among older adults with suspected cognitive impairment: A registry-based cross-sectional study

Ben Kamsvaag; Sverre Bergh; Jūratė Šaltytė Benth; Richard C. Oude Voshaar; Kjerstin Tevik; Geir Selbaek; Anne-Sofie Helvik

doi:10.1371/journal.pone.0340484

Peer Review History

Original SubmissionNovember 6, 2025
9 Dec 2025 Decision Letter - Gihyun Yoon, Editor Dear Dr. Kamsvaag, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jan 23 2026 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. 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We look forward to receiving your revised manuscript. Kind regards, Gihyun Yoon, MD Academic Editor PLOS One Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1.Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. 3. Thank you for uploading your study's underlying data set. Unfortunately, the repository you have noted in your Data Availability statement does not qualify as an acceptable data repository according to PLOS's standards. At this time, please upload the minimal data set necessary to replicate your study's findings to a stable, public repository (such as figshare or Dryad) and provide us with the relevant URLs, DOIs, or accession numbers that may be used to access these data. For a list of recommended repositories and additional information on PLOS standards for data deposition, please see https://journals.plos.org/plosone/s/recommended-repositories . 4. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 5. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: 1. Abstract: Include the names of the primary outcome variables in the abstract section. 2. Abstract: Revise the sentence “Linear regression analysis was applied to assess the relationship between ICD-10 alcohol-related diagnoses and costs of (1) primary healthcare and (2) specialist health care.” to reduce confusion by emphasizing the primary outcome variable (healthcare costs). If the distinction between primary and specialist healthcare is not central, remove it from the abstract. 3. Figure 1 is difficult to interpret. Please revise it in the style of a CONSORT flowchart for clarity. 4. Page 19, line 302: Correct “pear year” to “per year.” [Note: HTML markup is below. Please do not edit.] Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes ****** Reviewer #1: The authors have done a commendable job in presenting a complex analysis with a large data set in a way that is coherent, organized, scientifically sound, and yields understandable results. The discussion is balanced and has a clear take home message. ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy Reviewer #1: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation. NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications. https://doi.org/10.1371/journal.pone.0340484.r001
Revision 1
18 Dec 2025 Author Response Dear Editor and Reviewer. Thank you for your consideration and helpful feedback. We have made necessary adjustments according to the full list included in the e-mail sent to us on December 10th, and have organized our response according to each point of the list as follows: 1. PLOS ONE style requirements: The style requirements have been reviewed after making the necessary adjustments to the manuscript, and the manuscript should still be correct as far as we are aware. Thus, no changes were made. 2. Grant information conflict: As per the Editor’s request, we have now changed the name of the funding source to “Innlandet Hospital Trust” in the online submission system, to match the Financial Disclosure statement of the PDF build. Please note that this name was not automatically identified in the online submission system, so we had to enter it manually (only the Norwegian name, “Sykehuset Innlandet HF”, was listed). The grant number 150919 was correct in both instances (i.e., both Financial Disclosure and Funding Information), and was therefore left unchanged. 3. Data availability: Data cannot be shared publicly due to ethical and legal restrictions related to participant confidentiality, imposed by the Norwegian National Centre for Ageing and Health, the Norwegian Institute of Public Health, and the Data Protection Office of Innlandet Hospital Trust. Therefore, we have not attempted to upload our study’s underlying dataset; the previous data availability statement merely made a referral to the Norwegian Prescribed Drug Registry, where researchers who meet the criteria for access to confidential data may request access to the dataset. To make this distinction more clear, the data availability statement in the online submission system has been updated as follows: “Data cannot be shared publicly due to ethical and legal restrictions related to participant confidentiality, imposed by the Norwegian National Centre for Ageing and Health, the Norwegian Institute of Public Health, and the Data Protection Office of Innlandet Hospital Trust. The dataset consists of sensitive, in-depth quantitative data regarding participants diagnosed with cognitive impairment and/or alcohol use disorders. Furthermore, participants consented to the use of their data solely within the scope of the present study, as approved by the South-Eastern Regional Committee for Medical Research Ethics (REK). Therefore, the dataset cannot be made publicly available. Researchers who meet the criteria for access to confidential data may request access to the dataset by contacting the institutional representatives at the Norwegian Prescribed Drug Registry, who were responsible for data linkage: lmr.data@fhi.no. For questions related to data privacy or ethical oversight, inquiries may be directed to Birgit Hovde at birgit.Hovde@sykehuset-innlandet.no (Data Protection Officer, Innlandet Hospital Trust).” 4. Previously published works: The reviewer comments included no recommendation to cite specific works. 5. Reference list: Only one new citation has been added to the manuscript, the 2025 CONSORT statement regarding the CONSORT flow chart standard (reference #94). The reference list has been reviewed and should be correct. 6. Addition Editor comments: a. Abstract primary outcomes: Page 2, lines 29-30: As per the Editor’s request, the primary outcome variable has now been named explicitly by revising the end of the sentence to “…the primary outcome variable: healthcare costs.” b. Abstract revision: Page 2, lines 29-30: As per the Editor’s suggestion, we have removed the distinction between the primary and specialist healthcare costs from the abstract, as it is not central to our study. c. Figure 1: Figure 1 has been revised according to CONSORT flow chart standards, as per the Editor’s request. The flow chart layout had to be adapted to match our research design, as our study is not a randomized trial. Lines 140-143 (page 7) were also revised to address this change. d. Page 19 line 304: “Pear year” has been corrected to “per year”. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0340484.r002
22 Dec 2025 Decision Letter - Gihyun Yoon, Editor Alcohol use disorders are associated with higher healthcare expenditure among older adults with suspected cognitive impairment: A registry-based cross-sectional study PONE-D-25-59078R1 Dear Dr. Kamsvaag, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support . If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Gihyun Yoon, MD Academic Editor PLOS One Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0340484.r003
Formally Accepted
Acceptance Letter - Gihyun Yoon, Editor PONE-D-25-59078R1 PLOS One Dear Dr. Kamsvaag, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS One. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Gihyun Yoon Academic Editor PLOS One https://doi.org/10.1371/journal.pone.0340484.r004

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