The impact of alcohol on society: Exploring the burden on police, ambulance, emergency departments and hospital

Abstract

Alcohol is a fundamental part of social life in many parts of the world. Problem drinking, however, is a major contributor to the global burden of disease. My thesis examines one slice of how alcohol contributes to harm in the Australian State of Victoria. I undertake a series of trend analyses of alcohol-related indicators, focusing on morbidity, mortality, serious road injuries and acute health service events, to explore the relative contributors to the alcohol burden in Victoria. I also conduct trend analyses to examine the way sex, age and region influence alcohol-related indicators. Using Joinpoint regression and linking a variety of different datasets together using deterministic matching, I examine: 1. Victorian alcohol-related morbidity trends (2000/01–2009/10) and mortality trends (2000 to 2007) for the whole Victorian population, and then stratified by sex, age and region. 2. Victorian alcohol-related serious road injury trends (2000/01 to 2009/10) for the whole Victorian population, and then stratified by sex, age and region. 3. Metropolitan Victorian acute alcohol-only intoxication ambulance attendance and the pathway of patients following ambulance transport, admission to emergency departments and hospital from 2004/05 to 2008/09, and then stratified by sex and age. The Victorian alcohol-related morbidity trend analysis revealed that the alcohol-related morbidity trend significantly increased. Significant differences were noted for morbidity rates and trends across all socio-demographic variables. By contrast, the Victorian alcohol-related mortality trend remained stable. Findings for alcohol-related mortality showed differences in rates between socio-demographics, but no differences in trends, which typically remained stable. The only exceptions were those aged 15‒24 years and 25‒44 years; the rate of change for these groups significantly decreased. The Victorian alcohol-related serious road injury trends analysis showed that, prior to the change in serious road injury definition by police, using alcohol hours as a proxy measure to examine trends is valid for data collected during high alcohol hours. High alcohol hours relate to the time of day and the day of week in which alcohol consumption is considered to be greatest and a likely contributor to the outcome of interest. Even when stratified by socio-demographics, my findings still suggested that using alcohol hours as a proxy measure to examine trends is valid for data during high alcohol hours, particularly when stratified by sex, focused on young Victorians aged 15‒24 years, and in metropolitan Victoria. My thesis also presents the first data linkage between three Victorian administrative datasets (ambulance, emergency departments and hospital) for alcohol ambulance attendances. Results highlighted that the monthly count of alcohol-only intoxicated patients has been increasing. Relative to this monthly count of alcohol-only intoxicated patients, the trend for the percentage of alcohol-only intoxicated patients being admitted to emergency departments and hospitals showed, overall, stable trends. Findings show, relative to the Victorian population, an increase in the rate of alcohol-only intoxicated patients attended to by paramedics and admitted to emergency departments (between August 2004 and December 2007). Overall, my thesis highlights increasing alcohol-related morbidity and stable mortality trends in Victoria, against the backdrop of stable consumption patterns. This suggests that the rate of incidence in alcohol-related problems is growing, at least in Victoria and particularly for females, people aged between 25‒64 years, and those living in metropolitan Victoria. My findings support previous Australian research indicating increased female alcohol consumption and increased risky drinking trends by those aged 20‒59 years. Contrary to other Australian reports, however, I have also found that the rate and trend for alcohol-related morbidity was greater for metropolitan compared to regional Victoria. The most striking results of my thesis were the results for female morbidity, mortality, serious road injuries and, to some degree, demand for emergency services. Victorian females showed the fastest increases in morbidity and deviated from the declining male mortality trend. Females showed either flat or increasing trends in alcohol-related serious road injuries compared to males, who showed either flat or decreasing trends. Finally, trends indicated that females’ demand for emergency services appeared to be converging with male trends. In conclusion, my thesis contributes to a better understanding of trends in alcohol-related morbidity, mortality, serious road injuries and acute health service events in the Australian State of Victoria. My findings are positioned to inform Victorian policies and public health strategies which aim to reduce alcohol-related harm and suggest it is time for Victorian policies and strategies to extend their focus beyond the traditional risk groups (i.e., males, young people and regional areas) to Victorian females, people over 24 years of age and people living in metropolitan Victoria.