Alcohol-related Emergency Department Visits Research Articles

Alcohol Exclusion Laws and Its Drawbacks

Alcohol Exclusion Laws and Its Drawbacks

Characterizing the clinical subgroups of individuals who present to the emergency department for alcohol-related harms in Ontario, Canada: A latent class analysis

Alcohol-related emergency department (ED) visits are common and associated with adverse clinical outcomes, including premature mortality. This population-based retrospective cohort study identified clinically distinct subgroups of individuals who experience alcohol-related ED visits and characterized differences in the risk of adverse outcomes between them. 73,658 individuals who experienced an alcohol-related ED visit in Ontario, Canada between 2017 and 2018 were identified. Latent class analysis (LCA) revealed five clinically distinct subgroups within the overall cohort. These subgroups followed a severity gradient from low-frequency service use for acute intoxication to high-frequency service use for alcohol use disorder (AUD) and related comorbidities. Relative to those presenting for acute intoxication, those presenting for AUD and comorbidities had a much higher risk of hospital admission (adjusted odds ratio [aOR]: 8.26, 95 % confidence interval [CI]: 7.81–8.75) and post-discharge mortality (adjusted hazard ratio [aHR]: 3.07, 95 % CI: 2.81–3.37). There was a subgroup of individuals with a history of high frequency alcohol-related health service use who were at the highest risk of experiencing another alcohol-related ED visit after the index event (aHR: 4.76, 95 % CI: 4.55–4.99). Individuals who experience alcohol-related ED visits are not a homogenous population, but a constellation of subgroups with different clinical characteristics and risk of adverse outcomes.

Emergency Department Visits at Veteran’s Health Administration Hospitals Related to Alcohol Intoxication: A Ten-Year Retrospective

We sought to quantify and describe the volume of emergency department visits related to alcohol intoxication at the Veterans Health Administration (VHA), the largest healthcare system in the United States. This is a retrospective cohort study of patients with VHA emergency department visits for alcohol intoxication from 2010-2019 as identified via ICD-9/10 code and/or serum ethanol concentration >50mg/dL. Encounters were identified and demographic and clinical data were acquired by automated query of the VHA Corporate Data Warehouse. Descriptive statistics and univariate analysis were performed. We identified 95,123 patients with a total of 251,310 emergency department visits. The annual number of visits increased over the study period, reaching 32,333 in 2019. Men aged 40-60 were the most common demographic group in the cohort (48% of all patients), and men made up a high proportion of patients in the database (94%) than the VHA population overall (90%). A disproportionate number of visits (32%) came from the top 4.4% of most frequent visitors. Most of the emergency department visits in the database (68%) were associated with medical or psychiatric admission, or interfacility transfer for admission elsewhere. Patients in the cohort accounted for 1.3% of all VHA emergency department visits during the study period, a proportion which is somewhat smaller than what has been reported at non-VHA facilities, and despite the high prevalence of addiction disorders in the VHA patient population. We submit that this lower-than-expected proportion of alcohol-related emergency department visits may be due to the access to primary and mental care which is afforded by VHA patient benefits.

The Burden of Alcohol-Related Emergency Department Visits in a Hospital of a Large European City

(1) Alcohol consumption contributes to the development of numerous diseases and is a big organizational burden on emergency departments (EDs). (2) We examined data on alcohol-related ED admissions in Poznan, Poland between 1 April 2019 and 31 March 2022. A total of 2290 patients' records were collected and analysed. The main goal was to determine the impact that these visits had on the functioning of the ED and the hospital. (3) The alcohol-related admission rate was significantly higher in males (78.95% vs. 21.05%), and the median blood alcohol concentration (BAC) level was 2.60 (1.78-3.38) ‱. Most of the visits took place at weekends and in the evening. Patients with higher BAC tended to stay longer in the ED, but had a lower chance of being admitted. A majority of patients required radiology and laboratory testing, 20.44% needed psychiatric examination, and 19.69% suffered trauma, mainly to the head. (4) Injuries and mental problems were the most common medical emergencies. This study presents trends in alcohol-related ED attendances, examines reasons for visits, and makes an attempt to assess overall burden on EDs.

The Impact of Alcohol Sales in A College Football Stadium on Healthcare Utilization.

In 2021, a large Midwestern university began selling alcohol to spectators within the football stadium for the first time. The stadium routinely hosts >65,000 spectators, and drinking alcohol is highly prevalent at pre-game tailgating events. Our goal in this study was to determine the impact of in-stadium alcohol sales on the incidence of alcohol-related emergency department (ED) visits and local emergency medical services (EMS) calls. We hypothesized that the availability of alcohol throughout the stadium would lead to an increase in alcohol-related patient presentations. This was a retrospective study including patients who used local EMS and presented to the ED on football Saturdays in the 2019 and 2021 seasons. There were 11 Saturday games with seven home games each year. The 2020 season was excluded due to the impact of COVID-19- related restrictions on attendance. Trained extractors using predefined criteria reviewed records for each patient to determine whether the visit was alcohol related. Using logistic regression analysis we examined the odds of an EMS call and ED visit being alcohol-related before and after the start of stadium alcohol sales. We compared characteristics of visits before and after the onset of stadium alcohol sales using Student's t-test for continuous variables and chi-square test for categorical variables. In 2021, after the onset of in-stadium alcohol sales, there were a total of 505 emergency calls to local EMS on football Saturdays (home and away), and 29% of them were for alcohol-related incidents down from 36% of 456 calls in 2019. After adjustment for covariates, the odds of a call being alcohol-related were lower in 2021 than 2019, but this difference was not significant (adjusted odds ratio [aOR] 0.83, 95% CI 0.48-1.42). Looking specifically at the seven home games each season, the difference was more pronounced (31% of calls in 2021 compared to 40% in 2019) but not statistically significant after adjustment for covariates (aOR 0.54, 95% CI 0.15-2.03). In the ED, 1,414 patients were evaluated on game days in 2021 and 8% of them for alcohol-related reasons. This is similar to 2019, when 9% of the 1,538 patients presented due to alcohol-related complaints. After adjustment for covariates, the odds of an ED visit being alcohol-related were similar in 2021 and 2019 (aOR 0.98, 95% CI 0.70-1.38). There was a decrease in alcohol-related EMS calls on home game days in 2021, although the result was not statistically significant. In-stadium alcohol sales had no significant impact on the frequency or proportion of alcohol-related ED visits. The reason for this outcome is unclear, but it is possible that fans drank less at tailgate parties knowing they could consume more once the game started. Long lines and a two-beverage limit at stadium concessions may have kept patrons from consuming excessively. The results of this study may inform similar institutions regarding the safe implementation of alcohol sales during mass-gathering events.

Clarifying rural-urban disparities in alcohol-related emergency department visits and hospitalizations in Ontario, Canada: A spatial analysis.

Rates of alcohol-related harm are higher in rural versus urban Canada. This study characterized the spatial distribution and regional determinants of alcohol-related emergency department (ED) visits and hospitalizations in Ontario to better understand this rural-urban disparity. This was a cross-sectional spatial analysis of rates of alcohol-related ED visits and hospitalizations by Ministry of Health subregion (n = 76) in Ontario, Canada between 2016 and 2019. Regional hot- and cold-spots of alcohol-related harm were identified using spatial autocorrelation methods. Rurality was measured as the population weighted geographic remoteness of a subregion. The associations between rurality and rates of alcohol-related ED visits and hospitalizations were evaluated using hierarchical Bayesian spatial regression models. Rates of alcohol-related ED visits and hospitalizations varied substantially between subregions, with high rates clustering in Northern Ontario. Overall, increasing rurality was associated with higher subregion-level rates of alcohol-related ED visits (males adjusted relative rate [aRR]: 1.67, 95% credible interval [CI]: 1.49-1.87; females aRR: 1.78, 95% CI: 1.60-1.98) and hospitalizations (males aRR: 1.34, 95% CI: 1.24-1.45; females aRR: 1.59, 95% CI: 1.45-1.74). However, after the province was separated into Northern and Southern strata, this association only held in Northern subregions. In contrast, increasing rurality was associated with lower rates of alcohol-related ED visits in Southern subregions (males aRR: 0.87, 95% CI: 0.79-0.96; females aRR: 0.88, 95% CI: 0.81-0.97). There are regional differences in the association between rurality and alcohol-related health service use. This regional variation should be considered when developing health policies to minimize geographic disparities in alcohol-related harm.

Rural-urban disparities in post-discharge outcomes following alcohol-related hospitalizations in Ontario, Canada: A retrospective cohort study

BackgroundLimited access to mental health and addiction (MHA) services in rural areas may increase the risk of recurrent alcohol-related harm among rural, relative to urban, residents. This study evaluated (1) rural-urban differences in clinical trajectories following alcohol-related hospitalizations and (2) whether limited access to MHA services mediates an increased risk of adverse post-discharge outcomes in rural areas. MethodsThis was a population-based retrospective cohort study of individuals in Ontario, Canada, who experienced an alcohol-related hospitalization between 2016 and 2018. The primary exposure was rurality. The outcomes of interest were outpatient MHA care, alcohol-related emergency department visits, alcohol-related hospitalizations, and all-cause mortality within one-year of discharge from the index alcohol-related hospitalization. Data were collected using provincial health administrative databases. The associations between rurality and the time to each outcome were assessed using multivariable time-to-event regression. Mediation analyses were conducted using a counterfactual approach. Results46,657 individuals were included. 11.5% of the cohort died within one year of discharge from the index alcohol-related hospitalization. Relative to urban residents, rural residents were less likely to receive MHA outpatient care (adjusted hazard ratio (aHR): 0.80, 95% confidence interval (CI): 0.75–0.86) and more likely to die (aHR: 1.19, 95% CI: 1.06–1.34) in the year following discharge. The lower likelihood of post-discharge MHA-related care among rural residents mediated 31% (95% CI: 13–46%) of the increased risk of mortality. ConclusionsA lack of follow-up MHA care mediates an increased risk of short-term mortality following alcohol-related hospitalizations in rural, relative to urban, communities.

Trends in emergency department visits related to acute alcohol consumption before and during the COVID-19 pandemic in the United States, 2018–2020

BackgroundExcessive drinking accounts for more than 95,000 deaths annually in the United States. Coronavirus disease 2019 (COVID-19) pandemic-related factors (e.g., social, economic, policy) may have affected alcohol consumption. Emergency department (ED) visits involving acute alcohol consumption (referred to as “alcohol-related”) are a useful indicator for assessing changes in alcohol-related harms. MethodsThe 2018–2020 National Syndromic Surveillance Program data, which include nonfatal ED visits from facilities in 49 states and Washington, DC, were analyzed. Trends in the number of alcohol-related ED visits among people ≥15 years, and weekly alcohol-related ED visit rates (per 10,000 total visits) overall, by demographic characteristics, and quarter (Q) were assessed. Quarterly rates for 2018 and 2019 were averaged to increase baseline data stability. ResultsAlcohol-related visits accounted for 1.6% of 60,474,770 total visits (2018), 1.7% of 61,564,380 total visits (2019), and 1.8% of 52,174,507 total visits (2020). The number of alcohol-related ED visits generally increased during the first eight months of 2018 and 2019. However, it sharply declined at the onset of the COVID-19 pandemic in mid-March–mid-April 2020, before resuming pre-pandemic patterns. Alcohol-related ED visits per 10,000 were higher during quarters in 2020 than corresponding quarters in 2018–2019 (Q1: +7.3%, Q2: +23.8%, Q3: +9.7%, Q4: +6.5%). ConclusionsAlcohol-related ED visit rates per 10,000 total visits increased during 2020 versus 2018–2019, with the greatest relative difference in the second quarter. Fewer people sought ED care in 2020 than 2018–2019 but alcohol-related visits declined to a lesser extent than total visits.

The impact of the COVID‐19 pandemic on alcohol‐related emergency department visits in the Netherlands: The ALCOVID study

IntroductionThe ongoing COVID‐19 pandemic has a profound impact on society and healthcare utilisation. Some studies found that alcohol consumption increased. While declines in non‐COVID emergency department (ED) visits have been observed worldwide, little is known about the impact of the COVID‐19 pandemic on the number of alcohol‐related ED visits. We aimed to examine the changes in alcohol‐related ED utilisation during the first year of the pandemic in the Netherlands. We assessed whether lockdowns, closure of the catering industry and alcohol bans were associated with changes in ED utilisation for alcohol‐related emergencies.MethodsWe performed a retrospective analysis of alcohol‐related ED visits in a Dutch trauma level 2 centre, comparing the pandemic year 2020 and using the year 2019 as a reference. Alcohol‐related ED visits were categorised as alcohol intoxication, alcohol‐related trauma or a combination of both.ResultsThere was an absolute decline of 23.3% in alcohol‐related ED visits during 2020 compared to 2019. The decline was most distinct during the second lockdown period (−60%, P ≤ 0.001), which included an alcohol ban. No significant differences were found in the type of alcohol‐related ED visits. The proportion of alcohol‐related ED visits remained similar (2.2% vs. 2%).Discussion and ConclusionsDespite reports of higher alcohol consumption, we observed a reduction of alcohol‐related ED visits during the COVID‐19 pandemic. The decline was most distinct during the second lockdown period, which included an alcohol ban. Further prospective studies are warranted to examine this possible association.

Intended and unintended consequences of the implementation of minimum unit pricing of alcohol in Scotland: a natural experiment

Background Scotland was the first country to implement minimum unit pricing for alcohol nationally. Minimum unit pricing aims to reduce alcohol-related harms and to narrow health inequalities. Minimum unit pricing sets a minimum retail price based on alcohol content, targeting products preferentially consumed by high-risk drinkers. This study comprised three components. Objectives This study comprised three components assessing alcohol consumption and alcohol-related attendances in emergency departments, investigating potential unintended effects of minimum unit pricing on alcohol source and drug use, and exploring changes in public attitudes, experiences and norms towards minimum unit pricing and alcohol use. Design We conducted a natural experiment study using repeated cross-sectional surveys comparing Scotland (intervention) and North England (control) areas. This involved comparing changes in Scotland following the introduction of minimum unit pricing with changes seen in the north of England over the same period. Difference-in-difference analyses compared intervention and control areas. Focus groups with young people and heavy drinkers, and interviews with professional stakeholders before and after minimum unit pricing implementation in Scotland allowed exploration of attitudes, experiences and behaviours, stakeholder perceptions and potential mechanisms of effect. Setting Four emergency departments in Scotland and North England (component 1), six sexual health clinics in Scotland and North England (component 2), and focus groups and interviews in Scotland (component 3). Participants Research nurses interviewed 23,455 adults in emergency departments, and 15,218 participants self-completed questionnaires in sexual health clinics. We interviewed 30 stakeholders and 105 individuals participated in focus groups. Intervention Minimum unit pricing sets a minimum retail price based on alcohol content, targeting products preferentially consumed by high-risk drinkers. Results The odds ratio for an alcohol-related emergency department attendance following minimum unit pricing was 1.14 (95% confidence interval 0.90 to 1.44; p = 0.272). In absolute terms, we estimated that minimum unit pricing was associated with 258 more alcohol-related emergency department visits (95% confidence interval –191 to 707) across Scotland than would have been the case had minimum unit pricing not been implemented. The odds ratio for illicit drug consumption following minimum unit pricing was 1.04 (95% confidence interval 0.88 to 1.24; p = 0.612). Concerns about harms, including crime and the use of other sources of alcohol, were generally not realised. Stakeholders and the public generally did not perceive price increases or changed consumption. A lack of understanding of the policy may have caused concerns about harms to dependent drinkers among participants from more deprived areas. Limitations The short interval between policy announcement and implementation left limited time for pre-intervention data collection. Conclusions Within the emergency departments, there was no evidence of a beneficial impact of minimum unit pricing. Implementation appeared to have been successful and there was no evidence of substitution from alcohol consumption to other drugs. Drinkers and stakeholders largely reported not noticing any change in price or consumption. The lack of effect observed in these settings in the short term, and the problem-free implementation, suggests that the price per unit set (£0.50) was acceptable, but may be too low. Our evaluation, which itself contains multiple components, is part of a wider programme co-ordinated by Public Health Scotland and the results should be understood in this wider context. Future work Repeated evaluation of similar policies in different contexts with varying prices would enable a fuller picture of the relationship between price and impacts. Trial registration Current Controlled Trials ISRCTN16039407. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 11. See the NIHR Journals Library website for further project information.

The 12 -year evolution of emergency department alcohol-related admissions in a student city

ABSTRACT Objective To investigate the trends in incidence of alcohol-intoxicated patients who present at the emergency department (ED), as well as the characteristics of these patients. Methods Retrospective observational study based on data collected from 2008 until 2019 in two EDs in Leuven, Belgium. As a routine ED procedure, a blood alcohol concentration (BAC) test is ordered for all patients suspected of alcohol use as a primary presenting sign. Patients older than 10 years of age with a BAC ≥ 0.1 g/L were included. BAC levels, age, gender and proportion of repeat admissions were analysed. Results The absolute number of patients with a positive BAC test increased from 1260 in 2008 to 1908 in 2019 (51.4%). Male-to-female ratio remained stable (2:1). In the University Hospital Leuven , the most represented age group shifted from 20–29 and 40–49 year olds (2008) to 50–59 year olds (2019). The most common age groups in Heilig Hart Leuven were 10–19 year olds and 20–29 year olds, which remained stable over the study period. The readmission rate was 18% within the entire study period with a range of 2 to 46 times. Conclusion Our study showed an annual increase in alcohol-related admissions. The highest rates of alcohol-related ED visits occurred in the age group 50–59. Patients with a repeat admission accounted for a large number of the total alcohol-related visits, placing a major burden on our healthcare system. It will be a challenge to timely detect patients at risk, regardless of their age, to prevent future ED admissions.

Opioid-related Emergency Department Visits During COVID-19 in a Large Health System.

Objective:Multiple states have reported increases in opioid overdose deaths during the coronavirus disease 2019 (COVID-19) pandemic, however little is known about opioid-related presentations to the emergency department (ED).Methods:This was a time series analysis of visits to 7 EDs in greater Chicago, Illinois from October 20, 2019 to July 25, 2020. We compared the number of ED visits for opioid-related diagnoses in the time period preceding the World Health Organization pandemic declaration (prepandemic period, October 20, 2019–July 3, 2020) to the time period following the World Health Organization declaration (pandemic period, March 8, 2020 to July 25, 2020) using a single-group interrupted time series analysis with Newey-West standard errors. We also present data on alcohol-related ED visits for comparison.Results:We evaluated a total of 177,405 visits across the 7 EDs during the study period. The mean number of weekly ED visits in the prepandemic and pandemic periods was 4841 and 4029 weekly visits, respectively. In the interrupted time series analysis, there was no significant immediate effect of the pandemic start on opioid-related ED visits (−0.44 visits per 1000 ED visits, 95% CI −2.47 to 1.58, P = 0.66), however, there was a significant immediate effect of the pandemic start on alcohol-related ED visits (−4.1, 95% CI: −8.25 to −0.01, P < 0.05).Conclusions:Despite reductions in overall ED visit volumes and alcohol-related visits during COVID-19, the number of opioid-related visits was not significantly reduced during the early pandemic. These data reinforce the need to provide comprehensive treatment services for opioid use disorder during the co-occurring COVID-19 and opioid crises.

Trends and risk markers of student hazardous drinking: a comparative analysis using longitudinally linked datasets in a public university

Aims This study compares the incidence and risk-markers of student alcohol intoxication-related emergency department (ED) visits and alcohol-related incidents reported to student affairs. Methods: Enrollment data were linked to ED visits with alcohol intoxication and to alcohol-related incidents reported to campus authorities within one year following the first (index) annual enrollment. Incidence, annual trends and associated risk markers were analyzed. Results: The cohort consisted of 204,423 students aged 16–49. Incidence rates of first ED visit with alcohol intoxication and alcohol-related incidents were 59/10,000 and 311/10,000 person-years, respectively. Both outcomes shared common risk-markers including age, gender, race/ethnicity, fraternity and sorority (FSL) membership, an existing diagnosis of depression, etc. Being an athlete was associated with a lower risk of alcohol-related ED visits, and transfer students were at lower risk for alcohol-related incidents. Conclusion: Linking enrollment data with hazardous drinking events can help in better monitoring of student hazardous drinking and targeting interventions. Highlights First longitudinal study documenting the incidence of extreme student alcohol misuse. There were rising trends in student risky drinking based on two independent datasets. Analysis identified a range of risk markers predictive of risky drinking behaviors. Linking multiple student datasets can timely identify high risk students.

P108: Alcohol-related emergency department visits by youth aged 12-24: trends over 4 years in one Canadian centre

Introduction: Recent evidence shows an increase in alcohol-related emergency department (ED) visits among youth. Highly publicized collegiate rituals such as Homecoming may create a climate for problematic alcohol use. This study describes the frequency of youth alcohol-related ED visits per year and during pre-specified ritualized drinking dates in one academic centre. Methods: This was a chart review of patients aged 12-24 with alcohol-related ED presentations between Sept 2013-Aug 2017. The National Ambulatory Care Reporting System (NACRS) database was searched for visits with ICD-10 codes related to alcohol. The Canadian Hospital Injury Reporting and Prevention Program (CHIRPP) database was also searched using the keyword alcohol. Duplicate visits were removed. Visits were excluded if patients had a history of psychosis, were held in the ED for involuntary psychiatric assessment, were homeless, were inmates from a correctional institute, if alcohol use was not mentioned and for complaints of sexual assault/domestic violence. Data abstraction by two reviewers used a standard form with variables predetermined. Differences were resolved with third party adjudication. Interrater reliability of the reviewers was assessed through duplicate review of 10% of randomly selected charts. A further 10% were assessed by a 3rd reviewer for extraction accuracy. Results: A total of 3,256 ED visits were identified with 777 meeting exclusion criteria. The remaining 2,479 visits were reviewed and subclassified into injury (51.8%), acute intoxication (45.1%) and mental health issue (3.2%). Interrater agreement was high for extracted variables with Kappa scores &gt; 0.8. Despite a decrease in the region's youth population during the study period (28,325 to 25,125), overall standardized ED visits by youth increased by 12% (66,538 to 78,129). Adjusted for population, youth alcohol-related visits increased by 86.4% from 1,557 in 2013-14 to 2,902 in 2016-17. Co-ingestion of other substances was reported in 292 (11.8%) of visits, with cannabis the most common (57%). The 17 pre-specified ritualized days saw 578 (23.3%) of ED visits. Conclusion: Alcohol-related ED visits in youth are increasing in our region. Ritualized drinking dates appear to be particularly risky for youth with high rates of observed ED utilization. Strategies to manage high volume ritual days are being piloted, including temporary diversion to an in-hospital sobriety centre.

Alcohol Medical Intervention Clinic: A Rapid Access Addiction Medicine Model Reduces Emergency Department Visits.

Problematic alcohol use accounts for a large proportion of Emergency Department (ED) visits and revisits. We developed the Alcohol Medical Intervention Clinic (AMIC), a Rapid Access Addiction Medicine (RAAM) service, to reduce alcohol-related ED re-utilization and improve care for individuals with alcohol problems. This article describes the AMIC model and reports on an evaluation of its impact on patients and the ED system. Individuals presenting to The Ottawa Hospital Emergency Departments (TOH-ED) for an alcohol-related issue were referred to AMIC. Using data collected via medical chart review, and also self-report questionnaires, we assessed ED visits, revisits, and changes in alcohol use and mental health symptoms in patients before and after receiving services in AMIC. The incidence of alcohol-related ED visits and re-visits from 12-month periods before and after the introduction of AMIC were compared using data from TOH Data Warehouse. Connections made to additional services and patient satisfaction was also assessed. For patients served by AMIC, from May 26, 2016 to June 30, 2017 (n = 194), there was an 82% reduction in 30-day visits and re-visits (P < 0.001). An 8.1% reduction in total alcohol-related 30-day TOH-ED revisit rates and a 10% reduction in total alcohol-related TOH-ED visits were found. After receiving AMIC services, clients reported reductions in alcohol use, depression, and anxiety (P < 0.001). AMIC demonstrated positive impacts on patients and the healthcare system. AMIC reduced ED utilization, connected people with community services, and built system capacity to serve people with alcohol problems.

Using Death Certificates to Explore Changes in Alcohol-Related Mortality in the United States, 1999 to 2017.

Alcohol consumption, alcohol-related emergency department visits, and hospitalizations have all increased in the last 2 decades, particularly among women and people middle-aged and older. The purpose of this study was to explore data from death certificates to assess whether parallel changes in alcohol-related mortality occurred in the United States in recent years. U.S. mortality data from the National Center for Health Statistics were analyzed to estimate the annual number and rate of alcohol-related deaths by age, sex, race, and ethnicity between 1999 and 2017 among people aged 16+. Mortality data contained details from all death certificates filed nationally. For each death, an underlying cause and up to 20 multiple or contributing causes were indicated. Deaths were identified as alcohol-related if an alcohol-induced cause was listed as either an underlying or multiple cause. Joinpoint analyses were performed to assess temporal trends. The number of alcohol-related deaths per year among people aged 16+ doubled from 35,914 to 72,558, and the rate increased 50.9% from 16.9 to 25.5 per 100,000. Nearly 1 million alcohol-related deaths (944,880) were recorded between 1999 and 2017. In 2017, 2.6% of roughly 2.8 million deaths in the United States involved alcohol. Nearly half of alcohol-related deaths resulted from liver disease (30.7%; 22,245) or overdoses on alcohol alone or with other drugs (17.9%; 12,954). Rates of alcohol-related deaths were highest among males, people in age-groups spanning 45 to 74years, and among non-Hispanic (NH) American Indians or Alaska Natives. Rates increased for all age-groups except 16 to 20 and 75+ and for all racial and ethnic groups except for initial decreases among Hispanic males and NH Blacks followed by increases. The largest annual increase occurred among NH White females. Rates of acute alcohol-related deaths increased more for people aged 55 to 64, but rates of chronic alcohol-related deaths, which accounted for the majority of alcohol-related deaths, increased more for younger adults aged 25 to 34. Death certificates suggest that alcohol-related mortality increased in the United States between 1999 and 2017. Given previous reports that death certificates often fail to indicate the contribution of alcohol, the scope of alcohol-related mortality in the United States is likely higher than suggested from death certificates alone. Findings confirm an increasing burden of alcohol on public health and support the need for improving surveillance of alcohol-involved mortality.

Gender Differences in the Epidemiology of Alcohol Use and Related Harms in the United States.

Over the past century, differences in alcohol use and related harms between males and females in the United States have diminished considerably. In general, males still consume more alcohol and experience and cause more alcohol-related injuries and deaths than females do, but the gaps are narrowing. Among adolescents and emerging adults, gaps in drinking have narrowed primarily because alcohol use among males has declined more than alcohol use among females. Among adults, alcohol use is increasing for women but not for men. Rates of alcohol-related emergency department visits, hospitalizations, and deaths all have increased among adults during the past two decades. Consistent with the changing patterns of alcohol use, increases in these outcomes have been larger for women. Recent studies also suggest that females are more susceptible than males to alcohol-induced liver inflammation, cardiovascular disease, memory blackouts, hangovers, and certain cancers. Prevention strategies that address the increases in alcohol consumption and unique health risks for women are needed.

Alcohol-related emergency department visits and income inequality in New York City, USA: an ecological study.

OBJECTIVESPrevious research has found that greater income inequality is related to problematic alcohol use across a variety of geographical areas in the USA and New York City (NYC). Those studies used self-reported data to assess alcohol use. This study examined the relationship between within-neighborhood income inequality and alcohol-related emergency department (ED) visits.METHODSThe study outcome was the alcohol-related ED visit rate per 10,000 persons between 2010 and 2014, using data obtained from the New York Statewide Planning and Research Cooperative System. The main predictor of interest was income inequality, measured using the Gini coefficient from the American Community Survey (2010-2014) at the public use microdata area (PUMA) level (n=55) in NYC. Variables associated with alcohol-related ED visits in bivariate analyses were considered for inclusion in a multivariable model.RESULTSThere were 420,568 alcohol-related ED visits associated with a valid NYC address between 2010 and 2014. The overall annualized NYC alcohol-related ED visit rate was 100.7 visits per 10,000 persons. The median alcohol ED visit rate for NYC PUMAs was 88.0 visits per 10,000 persons (interquartile range [IQR], 64.5 to 133.5), and the median Gini coefficient was 0.48 (IQR, 0.45 to 0.51). In the multivariable model, a higher neighborhood Gini coefficient, a lower median age, and a lower percentage of male residents were independently associated with the alcohol-related ED visit rate.CONCLUSIONSThis study found that higher neighborhood income inequality was associated with higher neighborhood alcohol-related ED visit rates. The precise mechanism of this relationship is not understood, and further investigation is warranted to determine temporality and to assess whether the results are generalizable to other locales.

Alcohol-related Emergency Department Visits Among Adolescents and Young Adults in Sherbrooke, Canada

ABSTRACTRésumé Objective: To describe alcohol-related emergency department (ED) consultations by adolescents and young adults, including severe alcohol intoxication. Method(s): This retrospective study was done in the 2 EDs of Sherbrooke (Quebec). All alcohol-related emergency visits among adolescent (12–17 years of age) and young adults (18–24 years of age) between January 1, 2012 and January 1, 2017 were described. Data include demographic information, the immediate drinking context leading to the ED consultation, means of transport, coingestion of other substances, laboratory data, clinical outcomes, and the type of counseling and follow-up services being offered. Results: On a total of 855 consultations, 56% were males. The median age was 20. Beverages with high alcohol content were consumed in 75% of cases. An altered level of consciousness was described in 68% of cases and 23% of patients had a condition presenting a potential threat to life. A majority of cases (57%) presented with at least 1 medical complication associated with alcohol intoxication. Only 29% had consumed a concurrent substance. The average blood alcohol concentration was 209 mg/dL. Half of patients were alone at the ED and only 52% were offered counseling and 40% a follow-up. Conclusions: Youth alcohol intoxication happens too often and is a serious medical emergency. Alcohol-related ED consultations are an opportunity for health professionals to intervene with youth. Young people need to be aware that beverages with high alcohol content can be extremely dangerous and alcohol regulations should be revised to restrict access to these products. Objectif: Décrire les consultations des services d’urgence liées à l’alcool par les adolescents et les jeunes adultes, y compris l’intoxication grave à l’alcool. Méthode(s): Cette étude rétrospective a été réalisée dans les deux services des urgences (SU) de Sherbrooke (Québec). Toutes les visites à l’urgence liées à l’alcool chez les adolescents (12-17 ans) et les jeunes adultes (18-24 ans) entre le 1er janvier 2012 et le 1er janvier 2017 ont été décrites. Les données comprennent les informations démographiques, le contexte de consommation immédiate qui a conduit à la consultation aux urgences, les moyens de transport, la co-ingestion d’autres substances, les données de laboratoire, les résultats cliniques et le type de services de conseil et de suivi proposés. Résultats: Sur un total de 855 consultations, 56% étaient des hommes. L’âge médian était de 20 ans. Des boissons à forte teneur en alcool étaient consommées dans 75% des cas. Un niveau de conscience altéré a été décrit dans 68% des cas et 23% des patients étaient atteints d’une affection pouvant constituer un danger de mort. Une majorité de cas (57%) ont présenté au moins une complication médicale associée à une intoxication alcoolique. Seulement 29% avaient consommé une substance concurrente. La concentration moyenne d’alcool dans le sang était de 209 mg / dl. La moitié des patients étaient seuls à l’urgence, 52% seulement avaient bénéficié d’une consultation et 40% d’un suivi. Conclusion: L’intoxication par l’alcool chez les jeunes est trop fréquente et constitue une urgence médicale grave. Les consultations aux urgences liées à l’alcool sont une opportunité pour les professionnels de la santé d’intervenir auprès des jeunes. Les jeunes doivent être conscients que les boissons à forte teneur en alcool peuvent être extrêmement dangereuses et les réglementations en matière d’alcool doivent être révisées pour limiter l’accès à ces produits.

Use of Near-Real–Time Data to Inform Underage Drinking Surveillance in Nebraska

ObjectiveThe objective of this pilot study was to develop and evaluatesyndromic definitions for the monitoring of alcohol-related emergencydepartment (ED) visits in near-real–time syndromic surveillance(SyS) data. This study also evaluates the utility of SyS ED data forthe monitoring of underage drinking.IntroductionUnderage drinking is a significant public health problem in theUnited States as well as in Nebraska1-2. Alcohol consumption amongunderage youth accounts for approximately 5,000 deaths each yearin the United States, including motor vehicle crash related deaths,homicides and suicides1. In Nebraska, 23% of 12-20 year olds havereported alcohol use during the past 30 days3. In 2010, the estimatedtotal costs of underage drinking in Nebraska were $423 million.These costs included medical care, work loss along with pain andsuffering2. The health consequences of underage drinking includealcohol-related motor vehicle crashes and other unintentional injuries,physical and sexual assault, suicide, self-inflicted injury, death fromalcohol poisoning, and abuse of other drugs1, 4. The monitoring ofnear-real–time ED data could help underage drinking preventionefforts by providing timelier actionable public health information.MethodsNebraska SyS data from 32 ED facilities was analyzed for visitsof 12 to 20 year olds during October 1, 2015 to August 31, 2016.Three syndromic definitions were developed and tested for themonitoring of alcohol-related ED visits in near-real–time SyS databy using ESSENCE. The first and second definitions were based onquerying the chief complaint (CC) field for search terms associatedwith alcohol use and alcohol abuse or intoxication respectively.The third definition consisted of ICD-9-CM and ICD-10-CMdiagnostic codes associated to alcohol abuse or intoxication. Thesethree definitions were evaluated for internal consistency: reporteddiagnostic codes were used to evaluate the first and second definition,while text in the CC field was used to evaluate the third definition.Records with missing CC or diagnostic codes were excluded from theconsistency analysis. In addition, the CC field of records detected bythe third definition was evaluated for possible alcohol-related healthconsequences.ResultsA total of 126 cases were detected by using the first definition(CC search terms for alcohol use); 61% (50/82) of these identifiedalcohol abuse-related diagnostic codes. On the other hand, a totalof 64 cases were detected by using second definition (CC searchterms specific for alcohol abuse or intoxication); 89% (33/37) ofthese identified alcohol abuse-related diagnostic codes. The thirddefinition (diagnostic codes only) detected 111 cases; 49% (51/105)of these identified alcohol-related search terms in records withreported CC. However, keywords associated to alcohol-related healthconsequences, such as injury, assault, and use of other drugs werefound in records with no alcohol-related search terms in the CC field.Diagnostic codes associated to alcohol-related health consequenceswere observed in 93% (50/54) of these records. These results indicatethat alcohol use is underreported in the CC field.ConclusionsA higher internal consistency was observed for the syndromicdefinition based on CC search terms associated with alcohol abuseor intoxication. However, a syndromic definition based on diagnosticcodes is preferred due to the underreporting of alcohol use in the CCfield. The detection of underage alcohol use-related cases could beimproved by adding alcohol abuse or intoxication CC search termsto a syndromic definition based on diagnostic codes. Overall, resultsof this pilot study suggest that a syndromic definition based ondiagnostic codes can potentially enhance the surveillance of underagedrinking and alcohol-related health consequences.