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

Abstract

Objective 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). Methods 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). Results 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). Conclusion 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. Supplementary Information The online version contains supplementary material available at 10.17269/s41997-023-00739-8.

Outcomes in Clinical Subgroups of Patients With Alcohol-Related Hospitalizations

“…While this may be true, it would also be important to consider if there have been shifts in the relative distribution of types of hospitalization (eg, an increase in the proportion of hospitalizations for acute intoxication vs liver disease) that might underlie the overall changes in in-hospital mortality. Similar considerations should also be made when interpreting the results of other recent population-based analyses of alcohol-related health service use in Canada 4 , 6 , 7 , 31 , 32 and internationally. 34 , 35 , 36 Of course, there will be some variation in the subtypes of individuals who experience alcohol-related hospitalizations between jurisdictions.…”

“…All this research, including corroborating international reports, has generated substantial interest in monitoring national trends in alcohol-related hospitalizations and developing strategies to reduce the risk of postdischarge harm and recurrent health service use. However, much of this work amalgamates everyone who experiences an alcohol-related hospitalization into a single cohort of individuals with a presumed AUD . In turn, there has been relatively little focus on the clinical diversity that exists within this population or if certain subgroups merit prioritization in efforts to reduce the risk of adverse outcomes.…”

“…However, much of this work amalgamates everyone who experiences an alcohol-related hospitalization into a single cohort of individuals with a presumed AUD. 6 , 30 , 31 , 32 , 33 , 34 In turn, there has been relatively little focus on the clinical diversity that exists within this population or if certain subgroups merit prioritization in efforts to reduce the risk of adverse outcomes.…”

“…Alcohol-related hospitalizations are common among individuals with AUD and incur a large cost to health care systems around the world . As a result, there have been increasing efforts to understand the epidemiology of alcohol-related hospitalizations using population-based health administrative data . Identifying alcohol-related hospitalizations in these large data sets requires the use of indicators for alcohol-related harms, which are sets of diagnostic codes used to identify hospital records that are attributable to alcohol use .…”

“… 1 , 2 , 3 As a result, there have been increasing efforts to understand the epidemiology of alcohol-related hospitalizations using population-based health administrative data. 4 , 5 , 6 , 7 , 8 , 9 Identifying alcohol-related hospitalizations in these large data sets requires the use of indicators for alcohol-related harms, which are sets of diagnostic codes used to identify hospital records that are attributable to alcohol use. 4 , 9 , 10 Popular indicators include those developed by the Canadian Institute for Health Information (CIHI) 11 and the Centers for Disease Control and Prevention (CDC).…”