Background and Aims
In many countries, conflicting gradients in alcohol consumption and alcohol-associated mortality have been observed. To understand this ‘alcohol harm paradox’ we analysed the socio-economic gradient in alcohol-associated hospital admissions to test whether it was greater in conditions which were: (1) chronic (associated with long-term drinking) and partially alcohol-attributable, (2) chronic and wholly alcohol-attributable, (3) acute (associated with intoxication) and partially alcohol-attributable and (4) acute and wholly alcohol-attributable. Our aim was to clarify how (1) drinking patterns (e.g. intoxication linked to acute admissions or dependence linked to chronic conditions) and (2) non-alcohol causes (e.g. smoking and poor diet which are risks for partially alcohol-attributable conditions) contribute to the paradox.

Design
Regression analysis testing the modifying effects of condition-group (1–4 above) and sex on the relationship between area-based deprivation and admissions.

Setting
England, April 2010–March 2013.

Participants
A total of 9 239 629 English hospital admissions where a primary or secondary cause was one of 36 alcohol-associated conditions.

Measurements
Admissions by condition and deciles of Index of Multiple Deprivation (IMD). Socio-economic gradient measured as the relative index of inequality (RII, the slope of a linear regression of IMD on admissions adjusted for overall admission rate). Conditions were categorized by ICD-10 code.

Findings
A socio-economic gradient in hospitalizations was seen for all conditions, except partially attributable chronic conditions. The gradient was significantly steeper for conditions which were wholly attributable to alcohol and for acute conditions than for conditions partially alcohol-attributable and for chronic conditions. Gradients were steeper for men than for women in cases of wholly alcohol attributable conditions.

Conclusions
There is a socio-economic gradient in English hospital admission for most alcohol-associated conditions. The greatest inequalities are in conditions associated with alcohol dependence, such as liver disease and mental and behavioural conditions, and in acute conditions, such as alcohol poisoning and assault. Socio-economic differences in harmful drinking patterns (dependence and intoxication) may contribute to the ‘alcohol harm paradox’.

/pdf/understanding-the-alcohol-harm-paradox-an-analysis-of-sex-3txfbtjqj3.pdf

Understanding the alcohol harm paradox: an analysis of sex- and condition-specific hospital admissions by socio-economic group for alcohol-associated conditions in England.

This research investigated what Hospital Episode Statistics (HES) records could reveal about the development of problematic drinking careers among young people in England. A cohort of 7286 young people (aged 12-18) who had an index alcohol-related emergency admission between April 2003 and March 2004 were investigated for subsequent alcohol-related readmission. Regressions of patient and visit characteristics were performed against measures of readmission. A total of 677 patients (9.3% of the cohort) were readmitted during the following 3.75 years, and this group had on average 1.52 readmissions following their index admission. Predictors of having a first readmission included living in a deprived area at index admission (B = -.081, OR = .923, 95% CI = .894 to .952, df = 1, p < .001); having another substance use diagnosis (B = .302, OR = 1.352, 95% CI = 1.017 to 1.798, df = 1, p < .05), or a comorbid mental health diagnosis (B = .441, OR = 1.555, 95% CI = 1.147 to 2.108, df = 1, p < .01), or a diagnosis of self-harm (B = .316, OR = 1.371, 95% CI = 1.082 to 1.738, df = 1, p < .01) at index admission. These last three results were also associated with the readmission rate being higher for young women than young men (B = -.250, OR = .779, 95% CI = .656 to .925, df = 1, p < .01). Patients who had an injury diagnosis alongside their alcohol diagnosis were less likely to be readmitted in the future (B = -.439, OR = .645, 95% CI = .475 to .876, df = 1, p < .01) On average, each subsequent admission featured a longer hospital stay; was progressively more likely to occur on a non-traditional drinking day; and occurred after a progressively smaller number of days since previous admission. This study illustrates ways in which problematic drinking careers can be analysed using routinely collected health information, and the results from this analysis may be useful in informing the process of hospital screening and treatment referral. The effects of poverty and comorbid conditions on the initiation of a drinking career are suggested by these results.

/pdf/which-young-people-in-england-are-most-at-risk-of-an-alcohol-2buj9ox4zc.pdf

Which young people in England are most at risk of an alcohol-related revolving-door readmission career?

Variables associated with low, moderate and high emergency department use among patients with substance-related disorders.

The purpose of this study was to investigate the effects of alcohol intoxication in trauma patients in regard to its impact on application of computed tomography (CT) and associated radiation exposure. We conducted a retrospective study from a continuous patient cohort. Inclusion criteria: admission to the emergency room of an urban Level 1 trauma center with trauma team activation during a 12-month period (Jan 1st–Dec 31st 2012). Patients with incomplete data, age ≤ 12 years and with neurological diseases were excluded. Demographics, mechanisms, severity and patterns of injury (Abbreviated Injury Scale, Injury Severity Score, Glasgow Coma Scale), blood alcohol concentration (BAC, in permille, ‰), imaging studies (head/whole body CT), radiation exposure, and hospital length of stay, surgical procedures and mortality were evaluated with SPSS statistics (Version 25, IBM Inc., Armonk, New York). A positive BAC (mean 1.80 ± 0.767) was reported in 19.2% (n = 41/214) of the cohort. Alcohol intoxication was associated with higher utilization of head CT (65.9 vs. 46.8%, p = 0.017) and radiation exposure (231.75 vs. 151.25 mAS, p = 0.045; dose-length product, 583.03 vs. 391.04, p = 0.006). In general, the presence of alcohol was associated with over-triage (p = 0.001), despite minor injury severity (ISS < 9) and a comparable rate of head injuries (p = 0.275). Head injury (AIS ≥ 3) and positive BAC (OR 2.34, 95% CI 1.096–5.001) were identified as strongest independent predictors for head CT. Alcohol intoxication is a common finding in trauma patients, and the rate of moderate and serious head injuries seems to be comparable to a more severely injured control group. Furthermore, head CT utilization in intoxicated patients is associated with significant radiation exposure, despite poor image quality, due to motion artifacts (27%). Future strategies are required to exclude head injuries safely, while reducing the rate of head CT and associated radiation exposure in intoxicated patients.

/pdf/the-alcohol-intoxicated-trauma-patient-impact-on-imaging-and-21x43va7ha.pdf

The alcohol-intoxicated trauma patient: impact on imaging and radiation exposure

AIM: To assess the impact of Covid-19 on alcohol use disorders (AUD) and the role of universal alcohol screening (UAS) in an inpatient setting.

METHODS: Retrospective cohorts were defined as pre-pandemic and pandemic admitted to Nottingham University Hospitals (April to October; 2019 and 2020) and had alcohol assessment by AUDIT-C. AUDIT-C score was assessed against age, sex, ethnicity, admission type, speciality and primary diagnosis of mental disorders. Subgroup analysis for Covid-19 positive patients was performed.

RESULTS: A total of 63,927 admissions (47,954 patients) were included. The pandemic period compared to pre-pandemic had fewer overall admissions (27,349 vs 36,578, P < 0.001), fewer with AUD (17.6% vs 18.4%, P = 0.008) but a higher proportion of alcohol dependents (3.7% vs 3.0%, P < 0.0001). In the pandemic those with AUD were more likely to be male (P = 0.003), white (P < 0.001), in relationship (P < 0.001), of higher socioeconomic background (P < 0.001), have alcohol-related mental disorders (P = 0.002), emergency admission (P < 0.001), medical speciality admission (P < 0.001) and shorter length of stay (P < 0.033) compared to pre-pandemic AUD. Covid-19 positive patients with concomitant AUD died at younger age (P < 0.05) than Covid-19 positive patients at low risk for AUD.

CONCLUSIONS: The pandemic changed the characteristics of inpatients with AUD. There was a higher proportion of alcohol-dependent admissions with evidence that a younger, less deprived group have been significantly impacted. UAS provides a useful tool to screen for AUD and to identify the change when facing sudden health crises.

/pdf/the-effect-of-covid-19-on-alcohol-use-disorder-and-the-role-1bo8dwiosy.pdf

The Effect of Covid-19 on Alcohol Use Disorder and the Role of Universal Alcohol Screening in an Inpatient Setting: A Retrospective Cohort Control Study.

Objectives Alcohol is responsible for a proportion of emergency admissions to hospital, with acute alcohol intoxication and chronic alcohol dependency (CAD) implicated. This study aims to quantify the proportion of hospital admissions through our emergency department (ED) which were thought by the admitting doctor to be (largely or partially) a result of alcohol consumption. Setting ED of a UK tertiary referral hospital. Participants All ED admissions occurring over 14 weeks from 1 September to 8 December 2012. Data obtained for 5497 of 5746 admissions (95.67%). Primary outcome measures Proportion of emergency admissions related to alcohol as defined by the admitting ED clinician. Secondary outcome measures Proportion of emergency admissions due to alcohol diagnosed with acute alcohol intoxication or CAD according to ICD-10 criteria. Results 1152 (21.0%, 95% CI 19.9% to 22.0%) of emergency admissions were thought to be due to alcohol. 74.6% of patients admitted due to alcohol had CAD, and significantly greater than the 26.4% with ‘Severe’ or ‘Very Severe’ acute alcohol intoxication (p Conclusions Alcohol was thought to be implicated in 21% of emergency admissions in this cohort. CAD is responsible for a significantly greater proportion of admissions due to alcohol than acute intoxication. Interventions designed to reduce alcohol-related admissions must incorporate measures to tackle CAD.

https://bmjopen.bmj.com/content/bmjopen/6/6/e010005.full.pdf

Quantifying alcohol-related emergency admissions in a UK tertiary referral hospital: a cross-sectional study of chronic alcohol dependency and acute alcohol intoxication

F. Ritchie

Papers

Quantifying alcohol-related emergency admissions in a UK tertiary referral hospital: a cross-sectional study of chronic alcohol dependency and acute alcohol intoxication