The distribution of alcohol-attributable healthcare encounters across the population of alcohol users in Ontario, Canada

Alessandra T Andreacchi; Brendan T Smith; Jürgen Rehm; Jean-François Crépault; Adam Sherk; Erin Hobin

doi:10.1016/j.pmedr.2023.102388

The distribution of alcohol-attributable healthcare encounters across the population of alcohol users in Ontario, Canada

Prev Med Rep. 2023 Aug 25:35:102388. doi: 10.1016/j.pmedr.2023.102388. eCollection 2023 Oct.

Authors

Alessandra T Andreacchi^{1

2}, Brendan T Smith^{1

2}, Jürgen Rehm^{2

3

4

5

6

7

8}, Jean-François Crépault^{2

4}, Adam Sherk⁹, Erin Hobin^{1

2

9}

Affiliations

¹ Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON, Canada.
² Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
³ Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
⁴ Centre for Addiction and Mental Health, Toronto, ON, Canada.
⁵ WHO Collaboration Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada.
⁶ Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
⁷ Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
⁸ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
⁹ Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada.

Abstract

Recent evidence suggests there may be no safe level of alcohol use as even low levels are associated with increased risk for harm. However, the magnitude of the population-level health burden from lower levels of alcohol use is poorly understood. The objective was to estimate the distribution of alcohol-attributable healthcare encounters (emergency department (ED) visits and hospitalizations) across the population of alcohol users aged 15+ in Ontario, Canada. Using the International Model of Alcohol Harms and Policies (InterMAHP) tool, wholly and partially alcohol-attributable healthcare encounters were estimated across alcohol users: (1) former (no past-year use); (2) low volume (≤67.3 g ethanol/week); (3) medium volume (>67.3-134.5 g ethanol/week for women and >67.3-201.8 g ethanol/week for men); and (4) high volume (>134.5 g ethanol/week for women and >201.8 g ethanol/week for men). The alcohol-attributable healthcare burden was distributed across the population of alcohol users. A small population of high volume users (23% of men, 13% of women) were estimated to have contributed to the greatest proportion of alcohol-attributable healthcare encounters, particularly among men (men: 65% of ED visits and 71% of hospitalizations, women: 49% of ED visits and 50% of hospitalizations). The 71% of women low and medium volumes users were estimated to have contributed to a substantial proportion of alcohol-attributable healthcare encounters (47% of ED visits and 34% of hospitalizations). Findings provide support for universal alcohol policies (i.e., delivered to the entire population) for reducing population-level alcohol-attributable harm in addition to targeted policies for high-risk users.

Keywords: Alcohol use; Canada; Geoffrey Rose; Prevention paradox; Substance use; Universal policies.