Alcohol-related Diagnosis Research Articles

Shifts in Alcohol-Related Diagnoses After the Introduction of International Classification of Diseases, Tenth Revision, Clinical Modification Coding in U.S. Hospitals: Implications for Epidemiologic Research.

In October 2015, the United States transitioned healthcare diagnosis codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), to the Tenth Revision (ICD-10-CM). Trend analyses of alcohol-related stays could show discontinuities solely from the change in classification systems. This study examined the impact of the ICD-10-CM coding system on estimates of hospital stays involving alcohol-related diagnoses. This analysis used 2014 to 2017 administrative data from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project State Inpatient Databases for 17 states. Quarterly ICD-9-CM data from second quarter 2014 through third quarter 2015 were concatenated with ICD-10-CM data from fourth quarter 2015 through first quarter 2017. Quarterly counts of alcohol-related stays were examined overall and then by 6 diagnostic subgroups: withdrawal, abuse, dependence, alcohol-induced mental disorders (AIMD), nonpsychiatric alcohol-induced disease, and intoxication or toxic effects. Within each group, we calculated the difference in the average number of stays between ICD-9-CM and ICD-10-CM coding periods. On average, the number of stays involving any alcohol-related diagnosis in the 6 quarters before and after the ICD-10-CM transition was stable. However, substantial shifts in stays occurred for alcohol abuse, AIMD, and intoxication or toxic effects. For example, the average quarterly number of stays involving AIMD was 170.7% higher in the ICD-10-CM period than in the ICD-9-CM period. This increase was driven in large part by 1 ICD-10-CM code, Alcohol use, unspecified with unspecified alcohol-induced disorder. Researchers conducting trend analyses of inpatient stays involving alcohol-related diagnoses should consider how ongoing modifications in the ICD-10-CM code system and coding guidelines might affect their work. An advisable approach for trend analyses across the ICD-10-CM transition is to aggregate diagnosis codes into broader, clinically meaningful groups-including a single global group that encompasses all alcohol-related stays-and then to select diagnostic groupings that minimize discontinuities between the 2 coding systems while providing useful information on this important indicator of population health.

Characteristics of Frequent Users of Emergency Medical Services in Singapore

Objectives: This study aims to describe frequent users of Emergency Medical Services (EMS) conveyed to a Singapore tertiary hospital, focusing on a comparison between younger users (age <65) and older users in diagnoses and admission rates. Methods: All patients conveyed by EMS to a tertiary hospital 4 times or more over a 1-year period in 2015 had their EMS ambulance charts and Emergency Department (ED) electronic records retrospectively analyzed (n = 243), with admission the primary outcome. Results: The 243 frequent users were analyzed with a combined total of 1,705 visits, out of a total of 10,183 patients with 12,839 visits conveyed by EMS to Singapore General Hospital (SGH) in 2015. Younger frequent users (<65 years age) were found to be predominantly male (79.6%, p = 0.001) and were on average responsible for more visits than elderly frequent users (8.6 vs. 5.7, p = 0.004). Medical co-morbidities were significantly more prevalent in older users. Younger frequent users were more likely to be smokers (60.2% vs. 22.3%), heavy drinkers (51.3% vs. 8.5%), substance abusers (12.4% vs. 0.8%), and bad debtors (49.6% vs. 20.0%, p < 0.001). A larger proportion presented with altered mental states (11.7% vs. 5.4%, p < 0.001) and alcohol related diagnoses (34.7% vs. 5.3%, p < 0.001). Many were picked up from public areas (45.5% vs. 19.6%, p < 0.001), and had lower acuity triage scores at both EMS (p < 0.001) and ED (p = 0.001). They had lower admission rates (40.5% vs. 78.7%, p < 0.001) and shorter length of stay (4.3 vs. 5.9 days, p < 0.001). Univariable and multivariable analysis showed alcohol related diagnoses, history of alcohol abuse and lower triage scores were less likely to require admissions. Conclusion: Frequent EMS users consume a disproportionate amount of healthcare resources. Two broad subgroups of patients were identified: younger patients with social issues and older patients with multiple medical conditions. EMS usage by older patients was significantly associated with higher rates of admission

An exploratory case study of environmental factors related to military alcohol misuse

BackgroundAlcohol misuse has been an ongoing issue for the US Armed Services, with the Marine Corps maintaining the highest levels of problematic drinking. Broad environmental, social, and policy factors play an important role in alcohol misuse but are rarely studied as objective measures.MethodsThis case study used a pattern-matching approach to examine the associations between objective on- and off-base community environmental risk and protective factors and 4 objective alcohol-related outcomes at 3 large Marine Corps installations. The study utilized existing aggregated data from Marine Corps electronic data sources and information from internet searches of installation and community services and characteristics. Installation-level alcohol misuse outcomes included the rates of personnel receiving non-medical alcohol services, combined inpatient and outpatient alcohol-related primary diagnoses, alcohol-related domestic violence, and driving under the influence arrests. Installation-level environmental correlates included dollars spent on alcohol sales, density of alcohol outlets, extent of alternative activities, and installation and off-base sociodemographic factors.ResultsIn general, younger age, enlisted pay grade, and being stationed overseas were related with higher rates of alcohol-related problems among Marines. Greater on-base alcohol sales (both in bars and stores), as well as a greater density of restaurants and bars that serve alcohol, were associated with alcohol misuse outcomes. Several community factors were also associated with alcohol misuse. The hypothesized protective effects of alternative activities were inconsistent.ConclusionsFindings suggest that environmentally-oriented strategies, particularly restricting on-base sales of alcohol, may help to reduce alcohol-related harm in the Marine Corps.

Dementia and cognitive disorder identified at a forensic psychiatric examination - a study from Sweden

BackgroundFew studies have addressed the relationship between dementia and crime. We conducted a study of persons who got a primary or secondary diagnosis of dementia or cognitive disorder in a forensic psychiatric examination.MethodsIn Sweden, annually about 500 forensic psychiatric examinations are carried out. All cases from 2008 to 2010 with the diagnoses dementia or cognitive disorder were selected from the database of the Swedish National Board of Forensic Medicine. Out of 1471 cases, there were 54 cases of dementia or cognitive disorder. Case files were scrutinized and 17 cases of dementia and 4 cases of cognitive disorder likely to get a dementia diagnosis in a clinical setting were identified and further studied.ResultsThere were 18 men and 3 women; Median age 66 (n = 21; Range 35–77) years of age. Eleven men but no women had a previous criminal record. There were a total of 38 crimes, mostly violent, committed by the 21 persons. The crimes were of impulsive rather that pre-meditated character. According to the forensic psychiatric diagnoses, dementia was caused by cerebrovascular disorder (n = 4), alcohol or substance abuse (n = 3), cerebral haemorrhage and alcohol (n = 1), head trauma and alcohol (n = 2), Alzheimer’s disease (n = 2), Parkinson’s disease (n = 1), herpes encephalitis (n = 1) and unspecified (3). Out of four persons diagnosed with cognitive disorder, one also had delusional disorder and another one psychotic disorder and alcohol dependence. An alcohol-related diagnosis was established in ten cases. There were only two cases of Dementia of Alzheimer’s type, one of whom also had alcohol intoxication. None was diagnosed with a personality disorder. All but one had a history of somatic or psychiatric comorbidity like head traumas, stroke, other cardio-vascular disorders, epilepsy, depression, psychotic disorders and suicide attempts. In this very ill group, the suggested verdict was probation in one case and different forms of care in the remaining 20 cases instead of prison.ConclusionsFew cases of dementia or cognitive disorder were identified by forensic psychiatric examinations. All but one suffered from a variety of serious mental and medical conditions affecting the brain. Alcohol abuse was prevalent.

Maternal alcohol use disorder and subsequent child protection contact: A record-linkage population cohort study

We examined the relationship between a maternal alcohol-use diagnosis, and the timing of diagnosis, and child protection outcomes in a Western Australian population cohort. This analysis made use of routinely collected linked administrative health and child protection data. Those in scope for the study were women who had a birth recorded on the Western Australian Midwives Notification System (1983–2007). Women with an alcohol related diagnosis (ICD 9/10) on relevant datasets formed the exposed group. The comparison cohort were frequency matched to the exposed cohort. Generalized linear mixed models and a proportional hazards model were used to examine the relationship between a maternal alcohol-use diagnosis and subsequent child protection contact. Children of women with an alcohol-use diagnosis were at significantly increased risk of a substantiated child protection allegation (OR=2.92, 95%CI=2.71–3.14) and entry into out-of-home care (OR: 3.78, 95% CI=3.46–4.13). The highest risk of child protection contact was associated with diagnoses received during pregnancy, and in the years immediately pre- or post-pregnancy. Children whose mothers have an alcohol-use diagnosis are at increased risk of contact with child protection services. Despite current public health recommendations, some women continue to drink heavily during pregnancy. Additional work is required to identify effective strategies to reduce heavy alcohol use in this population. Further, women who have been identified to have alcohol use issues require additional support, from multiple agencies, to reduce the potential negative impacts on their child.

Maternal alcohol use disorder and child school attendance outcomes for non-Indigenous and Indigenous children in Western Australia: a population cohort record linkage study

ObjectivesExamine the relationship between maternal alcohol use disorder and child school attendance outcomes for non-Indigenous and Indigenous children in Western Australia.DesignPopulation cohort study.SettingRoutinely collected linked administrative health, education and child...

Maternal Alcohol Use Disorder and Risk of Child Contact with the Justice System in Western Australia: A Population Cohort Record Linkage Study.

BackgroundEarly contact with the justice system is associated with a multitude of negative outcomes across the life course. This includes an increased risk of ongoing justice contact, social disadvantage and marginalization, and mental health and substance use issues. Children whose mothers have an alcohol use disorder may be at risk of early justice system contact, and we sought to quantify this relationship in a Western Australian cohort.MethodsThis population cohort study made use of linked administrative data. Those in‐scope for the study were women who had a birth recorded on the Midwives Notification System (1983 to 2007). The exposed cohort were mothers who had an alcohol‐related diagnosis (ICD9/10), recorded on administrative data. This included mental and behavioral disorders which were alcohol related, diseases which could be entirely attributed to alcohol and other ICD alcohol codes. These women were considered to have an alcohol use disorder, which was a proxy for heavy drinking. The comparison cohort was frequency‐matched sample with no alcohol‐related diagnosis identified on administrative data sets.ResultsAfter adjusting for potential confounders, children whose mothers had a maternal alcohol use disorder had a significantly increased odds of justice contact when compared to those whose mothers had no diagnosis (odds ratio [OR] = 1.79, 95% confidence interval [CI] = 1.60 to 1.99). Additional significant maternal factors associated with child justice contact included being Indigenous (OR = 5.14, 95% CI = 4.54 to 5.81), low maternal age, low socioeconomic status, being unmarried, and a history of a mental health problems. Significant child‐level factors, which were associated with increased odds of justice contact, included being male, a mental health diagnosis, child protection contact, parity, and academic failure.ConclusionsChildren who were exposed to a maternal alcohol use disorder had significantly increased odds of contact with the justice system. Additional risk was associated with being Indigenous and with markers of social disadvantage. These results suggest that prevention and early intervention services should span across agencies in an effort to reduce risk.

Maternal alcohol disorders and school achievement: a population cohort record linkage study in Western Australia

ObjectiveMaternal alcohol use disorder is a risk factor for a range of developmental outcomes in children. This study examines school achievement in children of Indigenous and non-Indigenous mothers with an...

Social outcomes associated with alcohol-related diagnoses: a population-based analysis using linked administrative data

ABSTRACT&#x0D; ObjectiveThe objective of this population health research is to identify the social burden associated with having an alcohol related diagnosis.&#x0D; MethodsWe used linkable population-based administrative data files held in the Population Health Research Data Repository to conduct our research, fiscal years 1990/91 to 2014/15. Data came from several domains including health, social services, justice, and the Canadian Census. We used ICD-9/10-CA codes from the hospital abstract database, medical claims data, and prescription drug data to identify individuals with an alcohol-related diagnosis. Individuals’ socioeconomic status was determined using neighbourhood-level income data from the Canadian Census. We matched, 3:1, diagnosed cases to individuals in our repository using on age, sex, income, and community area. We linked cases and matches to administrative data from justice and social services to identify social outcomes associated with having an alcohol-related diagnosis. Outcomes included receipt of income assistance, residence in publically funded social housing, having a child apprehended by child and family protective services, having a charge for driving under the influence recorded in the justice data, and having a charge for domestic violence recorded in the justice data. We modelled rates using generalized estimating equations from 5 years before date of diagnosis to a maximum of 20 years after date of diagnosis. Models tested for significant differences in rates between cases and matches both before and after diagnosis; as well, we tested for time trends in rates both before and after diagnosis.&#x0D; ResultsWe identified 52,991 individuals with an alcohol related diagnosis between 1990/91 and 2014/15: 34,145 males and 18,846 females. 80.3% of cases had a mental-health related alcohol diagnosis. Diagnoses followed a socioeconomic gradient with the greatest number of cases coming from low-income neighbourhoods. Cases had a significant spike in rates from one year before to one year after diagnosis date, compared with matches, across all indicators. When we followed individuals for 20 years after diagnosis, we found a significantly elevated rate of social service use and involvement with the justice system, across all outcomes, for all years.&#x0D; ConclusionReceiving an alcohol-related diagnosis is associated with subsequent increased use of social services and contacts with the justice system. Upstream efforts to reduce alcohol-related diagnoses may result in reduced use of social services and justice contacts.

Estimating the population effect of maternal alcohol use disorders on the educational achievement of children

ABSTRACTObjectivesPrevious research has identified that heavy maternal alcohol use impacts on a child’s health and development including poor cognitive and educational outcomes. However, very few studies have used objective measures of heavy alcohol-use and standardised school-based measures. Further, the magnitude of the effect of heavy maternal alcohol use on the educational outcomes of children in Australia is unknown. The primary aim of the project was to examine the association between in-utero and childhood exposure to maternal alcohol use disorder, which provides a proxy for heavy alcohol use, and children’s educational outcomes.&#x0D; ApproachThis Western Australian population cohort study made use of linked administrative data to compare the educational outcomes of a cohort of exposed children born between 1989 and 2007 whose mother had an alcohol related diagnosis recorded on health datasets, with children whose mother did not have a diagnosis. The exposed cohort of mothers was frequency matched on maternal age within Indigenous status, and year of child’s birth with a comparison cohort of mothers without an alcohol-related diagnosis. Records were linked with education records up to 2011, which included the results of standardised state and national testing for children (ages 8-14), and school attendance data (ages 6-18). Mixed multivariate models were used to examine the relationship between exposure, and timing of exposure in relation to pregnancy, and the risk of failure to meet educational benchmarks for reading, writing, spelling, numeracy and school attendance. Separate analyses were run for Indigenous and non-Indigenous children.&#x0D; ResultsA higher proportion of both Indigenous and non-Indigenous exposed children failed to reach minimum standards for all domains of testing compared to those in the unexposed cohort. The risk of failure in the exposed cohort remained significant with adjustment for a set of known confounders and there was no consistent relationship between timing of exposure and academic performance.&#x0D; ConclusionThis project provides a unique view of how maternal alcohol use disorders affect a child’s educational outcomes. The use of linked administrative data overcomes the use of retrospective recall of past behaviour, and self-reports of drinking patterns which may be considered socially unacceptable. Results of this project indicate that children whose mothers have an alcohol use disorder are academically at risk. These results suggest that routine monitoring of maternal alcohol use, early identification of at-risk children and intervention at both the school and family level may assist vulnerable children to reach academic benchmarks.

Identifying in-patient costs attributable to the clinical sequelae and comorbidities of alcoholic liver disease in a national hospital database.

The clinical sequelae and comorbidities of alcoholic liver disease (ALD) often require hospitalization. The aims of this study were to (1) compare the average costs of hospitalizations with ALD and the costs of hospitalizations with other alcohol-related diagnoses that do not involve the liver; and (2) estimate the percentage of the difference in costs between the ALD and non-ALD hospitalizations that may be attributed to ascites, protein-calorie malnutrition and other conditions. The 2012 National Inpatient Sample is a population-based cross-sectional database representing more than 94% of all discharges from community hospitals in the United States. Community hospitals in the United States. The sample included 72 531 hospitalizations with ALD and 287 047 hospitalizations with other alcohol-related diagnoses. The dependent variable was total in-patient costs. We estimated the contribution of ascites, protein-calorie malnutrition and other conditions to the difference in costs between patients with ALD and patients with other diagnoses. Average costs for ALD patients were $3188.4 higher than those for patients with other diagnoses ($13 543 versus $10 355; P<0.001). Among all conditions in the analysis, protein-calorie malnutrition had the largest impact on costs [$6501; 95% confidence interval (CI)=5956, 7045; P<0.001] accounting for 12% of the higher costs of ALD stays. Costs of hospital care for patients with alcoholic liver disease are higher than those for patients with other alcohol-related diagnoses. These increased costs are associated with specific clinical sequelae and comorbidities, with protein-calorie malnutrition-a largely preventable condition-making a substantial contribution.

Unemployment Is a Risk Factor for Hospitalization Due to Alcohol Problems: A Longitudinal Study Based on the Stockholm Public Health Cohort (SPHC).

This study examined the associations between unemployment and alcohol-related hospitalization or mortality and to what extent these associations may be confounded by alcohol consumption and alcohol problems before unemployment. The study was based on the Stockholm Public Health Cohort (SPHC), a population-based stratified random sample with a baseline questionnaire in 2002/2003 and record linkages up to year 2011. The final sample in the study consists of 15,841 people aged 18-60 years. Unemployment was defined as any registration at the public employment services during 2003-2005. The outcome was alcohol-related hospitalization and alcohol-related mortality during 2006-2011. Confounders were age, sex, and education, and we further adjusted for baseline alcohol consumption and alcohol-related hospitalization before the study period. Cox proportional hazard models were fit, and associations were expressed as hazard ratios (HRs). In the fully adjusted model, unemployment was associated with an increased risk of alcohol-related hospitalization or mortality, with a more than threefold hazard (HR = 3.38, 95% CI [1.81, 6.31]) compared with no unemployment during the exposure period. There was a moderate attenuating effect of prior alcohol consumption and alcohol-related hospitalization. Any unemployment in 2003-2005 was highly related to having experienced an alcohol-related diagnosis during the 6-year follow-up, even after controlling for risky use of alcohol and prior hospitalization.

Alcohol Consumption and Inpatient Health Service Utilization in a Cohort of Patients With Alcohol Dependence After 20 Years of Follow-up.

To examine the association between drinking levels and inpatient health service utilization in people with a lifetime diagnosis of alcohol dependence. A longitudinal prospective study was conducted in a cohort of patients with alcohol dependence who had undergone treatment in 1987. Current results refer to the association between drinking patterns at 20-year follow-up and subsequent inpatient health service utilization. At 20 years after baseline, 530 of 850 patients were alive with administrative data available. Follow-up interview was conducted on 378 patients. There were 88 refusals and 64 could not be traced. Three categories of alcohol consumption were established (abstainers, moderate drinkers and heavy drinkers) depending on the pattern of alcohol use during the last year prior to the evaluation. Health service utilization was based on official statistics, including admissions to general, rehabilitation and psychiatric hospitals. The time period analysed was 5 years after the assessment of drinking patterns. Admission rates were lowest for abstainers compared to people with moderate and heavy drinking. With respect to hospital days, heavy drinking was associated with significantly higher adjusted rates than both abstainers and moderate drinkers. Alcohol-related diagnoses in hospital admissions were more frequent for both moderate and heavy drinkers. Abstinence and moderate alcohol consumption were both associated with lower hospitalization in people with a lifetime diagnosis of alcohol dependence. Thus, not only abstinence-oriented treatment strategies but also those to reduce alcohol intake would reduce inpatient hospitalizations. Abstention and reduced drinking in lifetime alcohol-dependent patients were associated with lower health care utilization compared to heavy drinking. Alcohol treatment strategies for alcohol-dependent patients have a positive impact on the reduction in health care utilization. An increase in treatment rate for alcohol use disorders will consequently have marked population health improvements.

Comparison of AUDIT-C collected via electronic medical record and self-administered research survey in HIV infected and uninfected patients

BackgroundUsing electronic medical record (EMR) data for clinical decisions, quality improvement, and research is common. While unhealthy alcohol use is particularly risky among HIV infected individuals (HIV+), the validity of EMR data for identifying unhealthy alcohol use among HIV+ is unclear. Among HIV+ and uninfected, we: (1) assess agreement of EMR and research AUDIT-C at validated cutoffs for unhealthy alcohol use; (2) explore EMR cutoffs that maximize agreement; and (3) assess subpopulation variation in agreement. MethodsUsing data from the Veterans Aging Cohort Study (VACS), EMR AUDIT-C cutoffs of 2+, 3+, and 4+ for men (2+ and 3+ for women) were compared to research AUDIT-C 4+ for men (3+ for women). Agreement was compared by demographics, HIV, hepatitis C infection, and alcohol related diagnosis. ResultsAmong 1082 HIV+ and 1160 uninfected men, 14% and 22% had an EMR and research AUDIT-C 4+, respectively. Among 32 HIV+ and 115 uninfected women, 9% and 14% had an EMR and research AUDIT-C 3+. For men, EMR agreement with the research AUDIT-C 4+ was highest at a cutoff of 3+ (kappa=0.49). For women, EMR agreement with AUDIT-C 3+ was highest at a cutoff of 2+ (kappa=0.46). Moderate agreement was consistent across subgroups. ConclusionsEMR AUDIT-C underestimates unhealthy alcohol use compared to research AUDIT-C in both HIV+ and uninfected individuals. Methods for improving quality of clinical screening may be in need of investigation. Researchers and clinicians may consider alternative EMR cutoffs that maximize agreement given limitations of clinical screening.

Alcohol-related mortality among adults.

Risky, abusive and addictive consumption of alcoholic beverages greatly jeopardizes the drinker's health; it can harm third parties, affects the drinker's social relations and causes considerable costs to the national economy. National and international campaigns therefore aim to lower alcohol consumption and its consequences. Alcohol-related mortality is the most serious outcome of excessive alcohol consumption. Official statistics on causes of death include a number of entirely alcohol-related diagnoses. In 2014 an examination of deceased adults in Germany revealed a directly alcohol-related cause of death in 14,095 cases (20.8 for every 100,000 inhabitants). Such diagnoses were considerably more frequent for men than women, reaching a peak in the 55 to 64 age group. Overall, death from alcohol abuse is declining in Germany. Because by international standards there is still a relatively high consumption of alcoholic beverages in Germany, more action needs to be taken.

Hospital Admissions Before an Alcohol-Related Death Among Middle-Aged Employed Men and Women: A Cohort Study Using Routine Data.

Due to lack of appropriate longitudinal data, relatively little is known about how and when persons who ultimately die due to alcohol-related causes interact with hospitals during the years before death. Using routinely collected nationwide data, we aimed to establish the timing and causes of all hospitalizations during a 10-year period before an alcohol-related death. We traced back the timing and causes of all hospitalizations occurring during a 10-year period before death among men and women (n=2,981) who were aged 35 and in employment at study entry, and who died from alcohol-related causes at ages 45 to 54 in 1997 to 2007. The study data consisted of 80% of all persons living in Finland who died during the study period. Those who died at ages 45 to 54 without alcohol involvement were used as a reference group. Persons who ultimately died from alcohol-related causes had on average 7 (mean 7.4, SD 9.9) hospital admissions, and they spent on average 56days (mean 56.2, SD 105.1) in hospital during the study period. By the fifth year before death (from the year -10 to year -5), about three-fifths of these persons had been hospitalized due to any cause at least once, but less than one-third had a hospital admission with an alcohol-related diagnosis. Those who died without alcohol involvement had an average 9 hospital admissions (mean 9.3, SD 11.2), and they spent on average 81days (mean 81.2, SD 163.9) in hospital during the study period. The majority of employed middle-aged persons who ultimately died due to alcohol-related causes interacted with hospitals frequently and already several years before death. Additional research is warranted to evaluate whether enhanced patient management at hospitals targeted to this population could potentially reduce alcohol-related harms.

PWE-151 Alcohol-Related Admissions to A Central London Hospital: Too Little Coding; Too Much Resource: Abstract PWE-151 Table 1

Introduction Alcohol-related harm costs the NHS £3.6 billion per year, of which 78% is costs to the hospital.1 Alcohol is traditionally poorly coded in UK hospitals and so estimating alcohol-related admissions and the resources they consume can be challenging. Underestimation may adversely influence service requirements and underestimate the impact of cost reduction measures. Methods Hospital admissions to a Central London Hospital for a 101 day period were identified from four sources: A search of 25 alcohol-related ICD-10 discharge diagnosis codes; Patients reviewed by the alcohol liaison nurse; All CT Head scans completed were analysed for evidence of alcohol misuse; Patients attending The Accident and Emergency Department (A&E) with alcohol misuse. Results Over this 101 day period, 537 admissions in 349 individual patients with harmful/hazardous alcohol use were identified with a total of 2,855 inpatient bed days and 104 day case procedures. 237 (44%) of these admissions did not have an alcohol-related discharge code. The mean admission length was 5.3 days. Fifty-eight percent of these patients had presented to the hospital at least once in the previous year with a total of 914 attendances, resulting in 518 admissions. This estimates 1,941 admissions per year in patients who drink to excess and a total of 10,318 inpatient bed days, equating to 28 inpatients per day. Eighty percent of these were emergencies accounting for 9.5% of all emergency admissions to the hospital. The table lists the resources used by this cohort both during the index admission and over the past 12 months: Over the same period, A&E ordered 464 CT Head scans, of which 112 (24%) were due to alcohol with head injuries being the commonest indication (34.4% alcohol-related). Alcohol was involved in 133 (22.2%) scans done within 24 hours of admission, estimating almost 500 scans per year. Conclusion Our data demonstrates that alcohol admissions are poorly coded and therefore the extent of alcohol-related resource use is likely to be an underestimation. We expect there to be further admissions not picked up using the above methods. Alcohol-related admissions account for high resource use and the costs, in bed days alone, exceed £3,500,000 per year in a single hospital. Accurately coding admissions is crucial to ensure that this group of patients, with high resource use, can be identified so that measures can be taken to treat their alcohol misuse and reduce the burden on healthcare. Reference 1 Statistics on Alcohol: England, 2013. Health and Social Care Information Centre. 2013. Disclosure of Interest None Declared

Fathers’ alcohol consumption and risk of alcohol-related hospitalization in offspring before 60 years of age

Introduction: The aim of the present study was to investigate the association between exposure to fathers’ alcohol consumption and offspring’s own risk of alcohol-related hospitalization. Methods: Data on circumstances in childhood and adolescence, e.g. fathers’ alcohol consumption at different levels (never, rarely, occasionally, often), parental divorce, as well as offspring’s own risky use of alcohol, smoking and mental health were collected among 49,321 men (sons), born in 1949–51, during conscription for compulsory military training in 1969/70, i.e. at ages 18–20. Data on alcohol-related diagnoses were collected from the Swedish In-patient Care register 1973–2009. Results: The relative risk of alcohol-related diagnoses among sons after the age of 20 increased with increasing level of alcohol consumption in the fathers. Compared with sons whose fathers never drank alcohol, those with fathers who drank alcohol occasionally or often had an increased hazard ratio (HR) of later hospitalization with alcohol-related diagnoses of 1.77 (95% confidence interval (CI) = 1.57–1.99) and 3.69 (CI 95% = 3.16–4.32), respectively. The associations were markedly stronger when the men were followed from age 40 and onwards compared with follow-up between 20 and 40 years of age. Conclusion: Father’s alcohol consumption was associated with an increased relative risk of alcohol-related hospitalization in offspring in adulthood.

Abstract 108: Alcohol-related Diagnoses are Associated with High Mortality in Patients with Peripheral Arterial Disease

Background: Moderate alcohol consumption is associated with lower risk of peripheral vascular disease (PVD). However, in heavy drinkers the evidence is limited, and there is little data on the effects of heavy drinking in patients admitted with PVD. We sought to investigate the prevalence and association of alcohol-related diagnoses with in-hospital mortality in patients presenting with PVD. Methods: We performed a cross-sectional analysis of the 2011 Nationwide Inpatient Sample (NIS). Using logistic regression methods appropriate for the NIS sample design, we estimated mortality associated with alcohol-related diagnoses in PVD patients and evaluated factors that might modify the association between alcohol and death. Results: PVD accounted for 158,683 (0.5%) of adult in-patient admissions with an in-hospital mortality rate of 4.6%. Of PVD admissions, a total of 4089 (2.6%) had concomitant alcohol-related diagnosis. Alcohol-related diagnoses were associated with increased mortality in PAD patients after controlling for factors associated with alcoholism, including age, sex, liver disease, hypertension, diabetes, renal failure, arrhythmias, drug abuse, gastro-intestinal bleed, and smoking [adjusted-odds ratio 1.7; 95% CI (1.3 - 2.4); P-value lt 0.001]. None of the factors included in the regression analyses interacted with alcohol abuse in predicting mortality, possibly due to lack of power. Conclusion: Alcohol-related diagnoses were associated with a modest increase in the risk for death in individuals presenting with PAD. This risk was not accounted for by common alcohol-related comorbidities. As a component of global efforts to limit hospital deaths from PAD, future research should identify the factors underlying this association.

Alcohol‐related diagnoses and increased mortality in acute myocardial infarction patients: An analysis of the nationwide inpatient sample

Moderate alcohol consumption has been associated with lower risk of coronary heart disease death, but heavy alcohol consumption may increase risk. We sought to determine the association of alcohol-related diagnoses with in-hospital mortality in patients with acute myocardial infarction (AMI). Discharge data collected from all admissions recorded in the Nationwide Inpatient Sample (NIS) database from 2011. A cross-sectional analysis was performed using regression methods appropriate for the NIS sample design. The outcome measures were in-hospital mortality, length of stay, and cardiac procedures. AMI accounted for 610,963 (1.9%) of adult in-patient admissions, with an in-hospital mortality rate of 5.3%. Alcohol-related diagnoses were associated with increased mortality in AMI patients after controlling for factors associated with alcoholism including age, sex, liver disease, hypertension, diabetes, renal failure, peripheral vascular disease, arrhythmias, drug abuse, gastrointestinal bleed, and smoking (adjusted odds ratio [OR]: 1.5, 95% confidence interval [CI]: 1.2-1.7, P < 0.001). This association was significant in both ST-elevation myocardial infarction patients (adjusted OR: 1.7, 95% CI: 1.4-2.2, P < 0.001) and non-ST-elevation myocardial infarction patients (adjusted OR: 1.3, 95% CI: 1.0-1.7, P = 0.025). Chronic alcohol-related diagnoses were significantly associated with death, but acute alcohol effects (as estimated by withdrawal and intoxication) were not associated. Chronic alcohol-related diagnoses were associated with a modest increase in the risk for death in individuals presenting with AMI. This risk was not accounted for by common alcohol-related comorbidities. As a component of global efforts to limit hospital deaths from AMI, future research should identify the factors underlying this association. Journal of Hospital Medicine 2016;11:563-567. © 2016 Society of Hospital Medicine.