Survival of patients with alcohol use disorders discharged from an emergency department: a population-based cohort study

Abstract

ObjectivesThe aim was to study the cause-specific mortality of users of the emergency department (ED) who received a diagnosis of alcohol use disorder (AUD) in comparison with mortality of other users of the department.DesignA population-based prospective cohort study.ParticipantsAll patients aged 18 years and above who were subsequently discharged home from the ED during the years 2002–2008. A total of 107 237 patients were followed by record linkage to a nationwide cause-of-death registry: 1210 patients with AUD as the main discharge diagnosis and 106 027 patients in the comparison group. HR and 95% CIs were calculated.SettingED at Landspitali—the National University Hospital of Iceland, Reykjavik, Iceland. The hospital offers tertiary care and is the number one trauma centre and community hospital for the greater Reykjavik area. According to the population registry, 78% of the inhabitants of the area attended the ED during the study period.Results72 patients died in the AUD group and 4807 in the comparison group. The adjusted HR for all causes of death was 1.91 (95% CI 1.51 to 2.42). The HR for AUDs was 47.68 (95% CI 11.56 to 196.59) while for alcohol liver disease the HR was 19.06 (95% CI 6.07 to 59.87). The HR was also elevated for diseases of the circulatory system: HR 2.52 (95% CI 1.73 to 3.68); accidental poisoning: HR=13.64, (95% CI 3.98 to 46.73); suicide: HR=2.72 (95% CI 1.08 to 6.83); and event of undetermined intent: HR=10.89 (95% CI 4.53 to 26.16).ConclusionsAUD as the discharge diagnosis at the ED, among patients who were not admitted to a hospital ward but discharged home, predicts increased mortality. As the results conclusively show the vulnerability of these patients, one can question whether their needs are adequately met at the ED.

All-Cause and Cause-Specific Mortality Rates of Patients Treated for Alcohol use Disorders: A Meta-Analysis

“…Given that the included studies were predominantly conducted in advanced economies, recruited mostly middle-aged males, and that we reported rates for combined genders, the findings of this review are likely to be generalizable to similar AUD populations and not to other AUD populations with different demographic, clinical, socioeconomic, or other characteristics. An example of such a population might be that described by Gunnarsdottir et al, 58 where the AUD population was sampled in the emergency care setting, and consisted of a lesser proportion of males (63.7%) than ours and had mortality rates less than those found in this review (e.g., allcause mortality 12.62/1000 py vs. 28.08/1000 py). Secondly, we found significant heterogeneity in the metaanalyzed estimates of pooled crude mortality rates.…”

Risk of suicide following an alcohol-related emergency hospital admission: An electronic cohort study of 2.8 million people

“…A second study of AUD in Iceland identified 1200 patients with AUD among over 100,000 emergency department attendances with seven years’ follow-up [ 31 ]. AUD was associated with a higher risk of suicide, but with only 15 deaths from suicide the estimates were imprecise.…”

The risk relationships between alcohol consumption, alcohol use disorder and alcohol use disorder mortality: A systematic review and meta‐analysis

“…Of the initial 5904 records screened for inclusion, a total of 10 studies were included in the systematic review, seven of which were eligible for quantitative synthesis [27,[32][33][34][35][36][37], in addition to two secondary US data sources (i.e. NESARC and NHIS) (Figure 2).…”