Alcohol-related Emergency Department Research Articles

Summer alcohol-related emergency department workload and occupancy in Australasia 2019-2022.

Alcohol is a major public health issue and the ACEM funds regular 'snapshot' surveys of the prevalence of alcohol-related presentations in EDs. The present study uses these data to investigate ED occupancy and alcohol- and methamphetamine-related presentations at the time of the COVID-19 pandemic. Survey-based point prevalence study of EDs in Australia and New Zealand conducted at 02:00 hours local time on the Saturday of the weekend before Christmas in 2019-2022. Primary outcomes were ED occupancy, the number of alcohol-related presentations and methamphetamine-related presentations in each ED at the time of survey. Seventy eight of a possible 152 hospitals answered all four surveys (51%, 95% confidence interval 43-59, individual yearly response rates ranged from 70.5% to 83.3%). The mean number of alcohol-related presentations in EDs at the snapshot time was 4.2 (95% confidence interval 3.2-5.2) in the 2019 survey and 3.8 (3.1-4.6) in 2022 with no significant variation over time. There was also no change in methamphetamine-related presentations which occurred at a lower level. There was a major increase in reported total ED occupancy - from 31.4 to 43.5 in Australia (P < 0.0001, paired t test) and from 22.8 to 38.7 in New Zealand (P = 0.0001). Subgroup analysis showed that both the number being treated and the number waiting to be seen increased, with little change in the number in observation units. The present study demonstrates that the COVID-19 pandemic did not affect summer alcohol-related ED presentations in Australasia but was associated with an unsustainable increase in ED crowding.

Changes in alcohol-related emergency department presentations—a comparison of three waves in 2013, 2017 and 2022

aims: Emergency departments (EDs) around the world are increasingly overcrowded, which is associated with significant patient harm. Alcohol use is a known contributor to ED overcrowding. This study aimed to assess trends in the characteristics of alcohol-related ED presentations over time. methods: A cross-sectional observational study of Christchurch ED attendances during 3-week waves of data collection in November–December 2013, 2017 and 2022 was conducted. Potential participants were those patients attending the Christchurch Hospital ED who had ingested alcohol in the 4 hours prior to arrival, and/or the presentation was thought to be related to alcohol. Those who consented to take part were interviewed to examine amount and source of alcohol. results: There has been a change in the age profile towards a greater proportion of older patients attending the ED with alcohol-related issues. In 2022, a greater proportion of alcohol was purchased from on-licence venues compared to previous years, although off-licence alcohol purchase and consumption in private locations remained the most common. conclusion: Alcohol use and harm places a significant, yet preventable, burden on EDs and the wider healthcare system. Implementation of evidence-based alcohol policies is urgently needed to reduce the impact of alcohol in the ED and improve the health of communities.

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.

Alcohol-related emergency department presentations and hospital admissions around the time of minimum unit pricing in Ireland

BackgroundMinimum unit pricing (MUP) was recently introduced in Ireland to reduce alcohol-related harms. The size of the impact of alcohol on hospital emergency departments (EDs) in Ireland is poorly understood due to inconsistent alcohol screening and documentation. AimsWe sought to systematically characterise the volume, timing, and nature of alcohol-related presentations and admissions to a busy urban ED in Dublin, Ireland. MethodPatients presenting to the ED were assessed by a dedicated clinician during selected time periods before (Nov–Dec 2021) and after (Feb–Apr 2022) the introduction of MUP. A total of 725 interviews were conducted over 168 h in the ED. FindingsAlcohol consumption was a factor in 19.4% of ED presentations and in 17.3% of hospital admissions across the entire study period. A reduction in overall alcohol-related ED presentations was noted in the period following MUP, although it is not possible to conclude a direct effect. ConclusionAlcohol-related harm places a significant strain on EDs and hospitals, and the impact of MUP on hospital burden in Ireland merits further evaluation. Effective measures at local and population levels are urgently required to address this burden.

Emergency department visits at Veterans 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 to 2019 as identified via ICD-9/10 code and/or serum ethanol concentration >50 mg/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 higher 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 that is somewhat smaller than what has been reported at non-VHA facilities, 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.

Using the Cardiff model to reduce late-night alcohol-related presentations in regional Australia.

The Cardiff model is a data sharing approach that aims to reduce the volume of intoxicated patients in emergency departments (EDs). This approach has not been tested in a rural setting. This study assessed whether this approach would reduce the number of alcohol-associated presentations during high-alcohol hours (HAH) in a regional ED. From July 2017, people over the age of 18 attending the ED were asked by the triage nurse (1) whether they had consumed alcohol in the past 12 h, (2) their typical alcohol consumption level, (3) the location where most alcohol was purchased and (4) the location of the last drink. From April 2018, quarterly letters were sent to the top five venues reported within the ED. Deidentified, aggregated data were shared with local police, licensing authorities and local government, identifying the top five venues reported in the ED and providing a summary of alcohol-related attendances to the ED. Interrupted time series analyses were used to estimate the influence of the intervention on monthly injury and alcohol-related ED presentations. ITS models found that there was a significant gradual decrease in the monthly rate of injury attendances during HAH (Coefficient=-0.004, p = 0.044). No other significant results were found. Our study found that sharing last drinks data collected in the ED with a local violence prevention committee was associated with a small, but significant reduction in the rate of injury presentations compared with all ED presentations. This intervention continues to have promise for reducing alcohol-related harm.

Three years of minimum unit pricing in the Northern Territory, what does the evidence say?

Three years of minimum unit pricing in the Northern Territory, what does the evidence say?

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.

Changes in health service use due to alcohol during the COVID-19 pandemic among individuals with and individuals without pre-existing alcohol-related medical diagnoses.

To compare changes in outpatient and acute care visits due to alcohol during the COVID-19 pandemic between individuals with and those without a history of alcohol-related health service use (AHSU). We conducted a cross-sectional analysis of health administrative data in Ontario, Canada. The Ontario population was stratified into those with and those without 1+ health service encounter(s) due to alcohol in the past 2 years. We compared age- and sex-standardized rates of alcohol-related outpatient visits, emergency department (ED) visits, and hospitalizations during the first 15 months of the pandemic (March 2020-May 2021) to those during the same 15-month period prior to the pandemic (March 2018-May 2019). Of 13,450,750 eligible Ontarians on March 11, 2022, 129,434 (1.0%) had AHSU in the previous 2 years. Overall, rates of alcohol-related outpatient visits and hospitalizations increased, while rates of alcohol-related ED visits decreased during the pandemic. There was a similar relative increase in rates of alcohol-related outpatient visits and hospitalizations between those with and those without prior AHSU. However, the absolute increase in rates of alcohol-related outpatient visits and hospitalizations was higher among those with prior AHSU (outpatient rate difference (RD) per 10,000 population: 852.3, 95% confidence interval (CI): 792.7, 911.9; inpatient RD: 26.0, 95% CI: -2.3, 54.2) than among those without (outpatient RD: 6.5, 95% CI: 6.0, 6.9; inpatient RD: 0.4, 95% CI: 0.2, 0.7). Rates of alcohol-related outpatient and inpatient care increased during the COVID-19 pandemic, and high rate of recurrent harm among individuals with pre-pandemic AHSU was an important contributor to this trend.

A new paradigm in management of frequent attenders to emergency departments with severe alcohol use disorder-A pilot study for assertive community treatment in Singapore.

A majority of frequent users of emergency medical services in Singapore present with alcohol-related problems. These patients are known to engage poorly with traditional addiction services and frequently attend Emergency Departments (EDs) instead, resulting in high healthcare burden. Assertive Community Treatment (ACT) is an alternative intervention to traditional addiction management. ACT involves community visits with focus on holistic care and harm-reduction. We conducted a prospective before-and-after cohort study at the major tertiary center for addiction disorders in Singapore. The main objective was to evaluate effectiveness of ACT in reducing alcohol-related attendances at EDs nationwide. Socio-demographics, alcohol-related ED attendances, and the Christo Inventory for Substance-misuse Services (CISS) scores were collected for the patients recruited from April 2018 to March 2019. Descriptive analyses and the Wilcoxon Signed-Rank Test were performed. All 14 patients were male with a mean age of 55 years. There was a significant 45.3% reduction in average alcohol-related ED attendances from 6.8 (range 3-22, median 5.5) in the pre-intervention 6-month period, to 3.7 (range 0-28, median 1.5) in the post-intervention 6-month period (Z = -2.244, p = 0.025). CISS scores showed significant improvement from a pre-intervention median of 13.5 (range 9-16) to a post-intervention median of 6.5 (range 1-10, p = 0.001), corresponding to reduction in alcohol-related problem severity. This pilot study suggests that ACT can be effective in reducing alcohol-related ED attendances and alcohol-related problem severity in patients with AUD who frequently attend ED. A multicenter, prospective study using ACT for such patients across four hospitals in Singapore is currently underway.

The impact of the COVID-19 pandemic on alcohol-related emergency department visits in a large European city

Introduction: The COVID-19 (Coronavirus infectious disease 2019) pandemic has caused global behavioural changes due to the need to remain in quarantine by large groups of the population. Earlier work on the effects of other epidemics on the human psyche has revealed a possible increase in the number of people who abuse alcohol as a method of coping with mental stress. Despite this, the studies on the COVID-19 pandemic have not shown a clear correlation between lockdowns and quarantines and an increase in alcohol consumption. This study focused on examining the impact of the pandemic on the number of alcohol-related attendances in the Emergency Department in Poznan (Poland). Material and methods: The periods of one year before the pandemic (control trial) and the first year of the COVID-19 pandemic (study group) were analysed retrospectively using the data of ED patients who were under the documented influence of alcohol. Total number, alcohol concentration, waiting time for a medical examination, the patient’s aggressive behaviour, length of stay in the ED, the need for additional examinations, suturing wounds or endotracheal intubation were analysed. Results: 954 patients were identified, which constituted 2.9% of all patients admitted to the ED during this period (the total number of patients admitted was 33510). During the control period, the total number of ED admissions was 30388 and 794 (2.6%) of them were in the control group. The median body alcohol concentration was 2.6%%. It has been shown that during the pandemic more women and fewer men under the influence of alcohol were admitted to the ED (212 (22.2%) females and 742 (77.8%) males) than in the pre-pandemic period [135 (17.0%) females and 659 (83.0%) males]. Additional examinations were performed less frequently (84.1% vs. 73.9%; p = 0.00000) and patients were admitted to other departments more often (25.7% vs. 40.9%; p = 0.00000). Other examined parameters did not change significantly. Conclusions: The study shows an increase in the number of patients under the influence of alcohol during the pandemic presenting to the ED and a noticeable change in management patterns’ variables such as shorter LOW, fewer performed laboratory tests and more admissions to wards. However, this data requires further analysis and comparison with studies from other centres to draw more general conclusions.

Triage and length of stay in emergency department visits due to alcohol intoxication: A retrospective chart review

BackgroundPatients with alcohol intoxication are screened and treated at emergency departments (EDs), at the cost of alcohol-related ED visit resource consumption. The purposes of this study were to identify characteristics of patients with alcohol intoxication, in terms of triage, blood alcohol concentration (BAC), and ED length of stay (LOS) and to compare these characteristics by homelessness status. MethodsWe conducted a retrospective chart review of all visits and referrals to one drunken center in an ED between January and December 2019. Adults aged over 18 years admitted to the drunken center with a blood alcohol concentration (BAC) of 100 mg/dl or higher were included. ResultsApproximately 89 % were male, around 30.4 % of the patients with acute alcohol intoxication were homeless. Approximately 46 % of patients were Medicaid or non-insured. Approximately 74.2 % of the patients were classified as KTAS 4 (less urgent) and 5 (nonurgency) upon initial KTAS evaluation. Both BAC and ED LOS were significantly higher in the homeless group. ConclusionsAbout half of alcohol intoxicated patients who visited ED were vulnerable, and they visited the ED due to the problem of less urgent or non-urgent status of triage. Sobering places, not ED, and connecting patients with social work programs is important.

Age at first alcohol-related hospital separation or emergency department presentation and rate of re-admission: A retrospective data linkage cohort of young Australians.

Alcohol is a leading risk factor for death and disease in young people. We compare age-specific characteristics of young people who experience their first ('index') alcohol-related hospitalisation or emergency department (ED) presentation, and whether age at index predicts 12-month rates of readmission. We used a retrospective linked-data cohort of 10,300 people aged 12-20 years with an index alcohol-related hospital and/or ED record in New South Wales, Australia from 2005 to 2013. Age group (early adolescent [12-14 years], late adolescent [15-17 years], young adult [18-20 years]) and diagnosis fields were used in logistic regression analyses and to calculate incidence rates with adjustment for year of index event, sex, socioeconomic disadvantage and residence remoteness. People who experienced their index event in early adolescence (adjusted relative risk ratio [ARRR] 0.45 [95% confidence interval 0.39, 0.52]) or late adolescence (ARRR 0.82 [0.74, 0.90]) were less likely to be male compared to young adults. Early adolescents (ARRR 0.60 [0.51, 0.70]) and late adolescents (ARRR 0.84 [0.76, 0.93]) were less likely to have a hospitalisation index event. Early adolescents (adjusted incidence rate ratio 1.40 [1.15, 1.71]) and late adolescents (adjusted incidence rate ratio 1.16 [1.01, 1.34]) were more likely than young adults to have a subsequent 12-month non-poisoning injury ED presentation. We identified preventable hospital events in young people who have previously experienced an alcohol-related ED presentation or hospitalisation, with age-specific characteristics and outcomes that can be used to inform future health policy and service planning.

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.