Emergency department outpatient treatment of alcohol-intoxicated bicyclists increases the cost of medical care in Japan

Abstract

Riding a bicycle under the influence of alcohol is illegal in Japan. Nevertheless, intoxicated bicyclists are frequently treated at hospital emergency departments for bicycle-related injuries. This patient population usually requires more hospital resources, even for relatively minor injuries. Therefore, we hypothesized that bicycle-related crashes involving bicyclists under the influence of alcohol cost more to treat than those that do not involve alcohol intoxication. The aim of the present study was to examine the costs associated with bicycle-related minor injuries and alcohol intoxication of the bicyclist. The study was conducted at the Tokyo Bay Urayasu Ichikawa Medical Center Emergency Department, Japan. All minor bicycle crashes involving 217 individuals aged ≥20 years treated from September 1, 2012 to August 31, 2013 were included in the analysis of data obtained from medical records. Variables included alcohol intoxication, sex, age, collision with a motor vehicle, Glasgow Coma Scale, injury severity score (ISS), laboratory tests, treatment of wounds, number of X-ray images, number of computed tomography scans, and medical costs. Multiple linear regression analysis was performed to evaluate the association between alcohol intoxication and medical costs. Seventy (32%) patients consumed alcohol, and the median medical cost was 253 USD (interquartile range [IQR], 164–330). Multivariable analysis showed that alcohol intoxication was independently associated with higher medical costs (p = 0.030, adjusted R-square value = 0.55). These findings support our hypothesis and should encourage authorities to implement comprehensive measures to prohibit bicycling under the influence of alcohol to prevent injuries and to reduce medical costs.

Cycling injuries and alcohol

“…Our main results demonstrated that one third of the injured cyclists were under the influence of alcohol at the time of attending the emergency hospital. Similar results were found in Tokyo [2] and Los Angeles, California [1]. According to a German database study, 57% of the cyclists involved in accidents had a BAC above 0.5 g/l, which is the maximum legal drink driving limit in Germany for a car or motorcycle [15].…”

“…The present study shows that the total direct and indirect costs of bicycle-related injuries treated in ED were higher among sober cyclists than among cyclists with AI, and constituted a total of 1984 s per patient (at the 2017 price level). However, in a study from Tokyo, Japan (minor bicycle accidents involving 217 individuals aged !20 years, treated in ED), alcohol intoxication was independently associated with higher medical costs [2]. Two similar results from Arizona and New York indicated that the alcohol-positive cyclists were more seriously injured and their healthcare costs were higher than those of the sober cyclists [5,21].…”

“…As cycling has become more popular, admissions to hospital due to cycling injuries are rising. According to previous studies, a third of patients tested for alcohol after bicycle-related accidents were found to be intoxicated [1,2]. Previous studies show that alcohol has a serious effect on cycling injuries.…”

“…A strong correlation has been shown between cycling under the influence of alcohol and head injuries [4]. Alcohol intoxication is associated with higher medical costs when patients are hospitalised or discharged as a result of bicycle-related injuries [1,2,5]. According to a German study, only 13% of injured cyclist cases could be found in police reports [3].…”

The influence of alcohol related accidents on health care cost

“…The literature showed that alcohol related traffic accident victims cost more to the health care system when compared to the cost of the victims after non-alcohol related accidents [26]. This literature does not include traffic accidents of pedestrians and cyclists [27,28]. Another study showed that in addition to financial burden of those alcohol caused traffic accidents to the health care system, those cases resulted in longer hospitalization periods at E.R.…”