New research shows dramatically rising visits to emergency departments (ED) related to alcohol

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New research shows dramatically rising visits to emergency departments (ED) related to alcohol, especially for women, with a 175% increase in alcohol-related visits from young people aged 25 to 29.

The article, published in CMAJ (Canadian Medical Association Journal), shows increases in ED visits related to alcohol that are occurring much faster than overall ED usage.

“These increases are consistent with data showing increasing average weekly alcohol consumption in Ontario and higher rates of binge drinking across Canada during the study period, particularly in women,” says lead author Dr. Daniel Myran, a family physician and public health resident at the University of Ottawa, Ottawa, Ontario.

The study included 765 346 ED visits by 480 611 people (32% from women) in Ontario, Canada’s largest province, because of alcohol between 2003 and 2016. Some findings:

  • Women who visited the ED due to alcohol were more likely to be under the legal drinking age of 19 years (17%) than men (9%).
  • The highest rates of alcohol-related visits were in women aged 15 to 24 and men aged 45 to 54.
  • In people aged 25 to 29, alcohol-related visits increased 240% in women and 145% in men.
  • ED visits for alcohol resulted in higher rates of hospital admission (13%) than general ED visits (10%).
  • Neighbourhoods in the lowest income bracket had more than twice the number of ED visits for alcohol compared with those in the highest income bracket.

“Since 2007, the rates of emergency department visits due to alcohol by women under legal drinking age has surpassed that of underage men,” says Dr. Myran, who is also training at The Ottawa Hospital and Bruyère Research Institute in public health.

“We need a better understanding of youth- and gender-specific risk factors for alcohol harms to curb these increases.”

These findings are consistent with data showing increases in alcohol-related ED visits in the United States (47% between 2006 and 2014) and England (51% between 2002 and 2014).

Data from the United States have also shown widening disparities in harms from alcohol between high- and low-income individuals.

While data from this study also highlight the disproportionate health burden that alcohol causes on lower-income individuals, this disparity has not grown over time.

The Canadian study differs in that there is less heavy drinking in lower-income groups in Canada than in the US, possibly because of policies that have prevented the sale of low-cost alcohol in Canada.

“There may be an increasing need for supports and services for people, especially young people, with high-risk alcohol consumption, particularly in light of recent changes to how alcohol is sold in Ontario, including making alcohol cheaper and easier to purchase,” says Dr. Myran.

The study was funded by Bruyère Research Institute through the Big Data Research Program and by ICES, which is funded by the Ontario Ministry of Health and Long-Term Care.

The ICES uOttawa subunit is also supported by The Ottawa Hospital Foundation and the University of Ottawa.

To minimize harms “the federal and provincial governments should employ a public health approach to maximize benefits and minimize harms,” writes Dr. Sheryl Spithoff, Department of Family and Community Medicine, Women’s College Hospital, Toronto, in a related commentary.

“Alcohol should be available for sale only within licensed and strictly monitored facilities with limited hours.

Taxes and price minimums should be used to reduce alcohol-related harms. The increase in tax revenues could be used to fund essential provincial programs.”


Many of the patients admitted to the emergency department (ED) present with toxic exposure.

According to domestic studies, patients visiting the emergency medical center with toxic exposure comprised 0.68%–5.5% of all visiting patients, and various causative substances and motives have also been reported.1 

It is considered that these patients might be exposed arbitrarily or by others and the sources and underlying motives will also vary according to societal influence and times.2,3,4

In Korea, excluding patients with chronic toxic exposure, most patients with symptomatic acute toxic exposure requiring treatment are treated through the ED.

Therefore, research on the characteristics of patients with acute toxic exposure visiting the ED is expected to be an important basis for the treatment of such patients.5,6,7 

Several countries have already reported the characteristics of toxic exposure through the analysis of national databases.8,9 

Korea has no national data because nationwide poisoning data are not collected yet and the majority of published data were single-center reports.

In addition, the epidemiological characteristics of toxic exposure are expected to vary with the times, but the published studies are mostly analyses spanning single years.10,11,12

Thus, the authors carried out this study to find out the epidemiological changes over time by extracting information related to poisoning through ED and insurance related databases already available nationwide.

The aim of this study was to investigate and analyze the epidemiological characteristics of toxic exposure among patients who visited the ED during a period of 5 years based on nationwide data to serve as a basis for recommendations regarding treatment.

RESULTS

Based on the data extracted from the HIRA, during the study period (2009–2013); 310,159 (2009), 289,829 (2010), 288,906 (2011), 285,514 (2012), and 279,575 (2013) patients, respectively, visited EDs with diagnoses related to exposure to toxic substances. Similarly, during the study period (2009–2013), a total of 3,991,212; 4,184,174; 4,513,047; 5,733,827; and 6,783,619 visits to ED, respectively were identified in the NEDIS database.

The epidemiologic characteristics of the patients were evaluated for patients identified through the HIRA database, and the total number of patients who visited EDs was examined using the NEDIS data in order to compare the characteristics among all patients who visited the EDs.

The number of patients who presented with acute toxic exposure compared to all ED visits significantly decreased consistently (7.8%, 6.9%, 6.0%, 5.0%, 4.1%) over 5 years.

According to gender, both men and women showed similar rates.

Regarding the type of insurance, the National Health Insurance accounted for the highest percentage each year.

By region, Seoul and Gyeonggi Province showed the highest number of visits in order, and visits through emergency rescue teams accounted for about 0.4% (Table 1).

Regarding the cause of toxic exposure, substances other than drugs accounted for the largest percentage, which increased annually.

Also, there was a high frequency of visits due to the aftermath of toxic damage, but this decreased rapidly every year.

Toxic exposure caused by drugs, alcohol and food was next in rank.

Among the drugs, antiepileptic medications accounted for a large proportion, enough to be in the 6th place alone, and sedatives and hypnotics ranked 8th.

Exposure to Clostridium spp. also occurred highly frequently, and ranked 7th and 9th. Poisoning due to other fish and shellfish was also confirmed to be highly frequent (Table 2).

The most commonly prescribed antidote was acetylcysteine, followed by naloxone.

The prescribed amounts of acetylcysteine, charcoal and flumazenil increased steadily, while the prescribed amounts of pralidoxime decreased steadily.

Gastric lavage was performed in about 0.1% of patients.

The average treatment period decreased rapidly in 2012 and 2013, compared to 2009, 2010 and 2011 (Table 3).

Patients aged 9 years or younger visited the ED most frequently (Fig. 1A), while patients who most frequently visited owing to toxic exposure were in their 40s and 50s (Fig. 1B).

According to the months of visit, the number of patients who visited EDs was lowest in February, highest in September, and increased rapidly in October and November 2009 (Fig. 2A). On the other hand, the number of patients with toxic exposure was highest in July–September and higher in January than the other months (Fig. 2B).


More information: Rates of emergency department visits attributable to alcohol use in Ontario from 2003 to 2016: a retrospective population-level study, CMAJ July 22, 2019 191 (29) E804-E810; DOI: 10.1503/cmaj.181575

Addressing rising alcohol-related harms in Canada, CMAJ July 22, 2019 191 (29) E802-E803; DOI: 10.1503/cmaj.190818

Journal information: Canadian Medical Association Journal
Provided by Canadian Medical Association Journal

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