Prevalence and patterns of hospital use for people with frequent alcohol-related hospital admissions, compared to non-alcohol and non-frequent admissions: a cohort study using routine administrative hospital data.

Abstract

This study compared prevalence and hospital use among individuals frequently admitted to hospital in England with wholly attributable alcohol-related diagnoses (WAAD), known as alcohol-related frequent attenders (ARFAs), with those of non-alcohol frequent attenders (NAFAs), non-frequent alcohol attenders (ARNFAs) and non-alcohol non-frequent attenders (NANFAs). Cross-sectional and longitudinal analyses of 5years of England's Hospital Episode Statistics (HES). Hospital inpatients in England, UK, 2011-16. Two cohorts (2011/12=489 580/7 654 944 patients and 2015/16=490 384/7 660 108 patients) were selected from all adult patients aged ≥18years, treated in English hospitals between 1 April 2011 and 31 March 2016. Patients were categorized as having alcohol-related admissions if diagnoses included a WAAD (ICD-10 classification, WHO, 2016) and frequent admissions if they had more than three hospital admissions during a single HES year. Prevalence of ARFA, number of admissions (spells), occupied bed-days (OBDs), average length of stay (ALOS) and total admission costs over 5years were compared among ARFAs, ARNFAs, NAFAs and NANFAs. On average, 0.7% of people admitted to hospital per annum in England 2011-15 were ARFAs and more than a quarter of all frequent attenders (for all causes) to hospitals had a wholly attributable alcohol diagnosis on admission. ARFAs had longer ALOS than the other patient groups [5.55days versus ARNFA 4.7, NAFA 3.39 and NANFA 2.57days, F=1088.37 (3, 488 570, P<0.001)] in the 2015/16 index year; but fewer spells than NAFAs [5.38 ARFAs versus 5.98 NAFAs, F=20 536.25 (3, 490 380) P<0.001]. The ARFA cohort reduced in size (from 51 934 ARFAs to 20 548) in the course of 5years. ARFAs had the highest average total cost of admissions per person over 5years at £38 189. People with repeated admissions for alcohol-related problems in England appear to be a high-cost, high-need, complex group of patients that makes up more than a quarter of the country's alcohol admissions.