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Introduction Alcohol‐related hospitalizations are common and associated with high rates of short‐term readmission and mortality. Providing rapid access to physician‐based mental health and addiction (MHA) services post‐discharge may help to reduce the risk of adverse outcomes in this population. This study used population‐based data to evaluate the prevalence of outpatient MHA service use following alcohol‐related hospitalizations and its association with downstream harms. Methods This was a population‐based historical cohort study of individuals who experienced an alcohol‐related hospitalization between 2016 and 2018 in Ontario, Canada. The primary exposure was whether an individual received follow‐up outpatient MHA services from either a psychiatrist or primary care physician within 30 days of discharge from the index hospitalization. The outcomes of interest were alcohol‐related hospital readmission and all‐cause mortality in the year following discharge from the index alcohol‐related hospitalization. Information on health service use and mortality was captured using comprehensive health administrative databases. The associations between receiving outpatient MHA services and the time to each outcome were assessed using multivariable time‐to‐event regression. Results A total of 43,343 individuals were included. 19.8% of the cohort received outpatient MHA services within 30 days of discharge. Overall, 19.1% of the cohort was readmitted to hospital and 11.5% of the cohort died in the year following discharge. Receiving outpatient MHA services was associated with a reduced hazard of alcohol‐related hospital readmission (adjusted hazard ratio [aHR] 0.94, 95% confidence interval [CI]: 0.88–0.99) and all‐cause mortality (aHR: 0.74, 95% CI: 0.66–0.83) after adjusting for demographic and clinical covariates. Conclusions Short‐term outcomes following alcohol‐related hospitalizations are poor. Facilitating rapid access to follow‐up MHA services may help to reduce the risk of recurrent harm and death in this population.

Purpose 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. Methods 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. Findings 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). Conclusions 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.