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Abstract
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Study Objective
Emergency physicians routinely encounter patients with alcohol-related visits to the emergency department (ED) and thus are well positioned to identify and intervene with these patients. The feasibility of doing so in EDs across California is unknown as there is a paucity of information of the true burden of alcohol-related injuries/illness in EDs in the state. The objective was to analyze California ED visit data for alcohol-related visits in order to more accurately measure ED alcohol injury/illness visit burden and further demographically characterize reasons for visits.
Methods
Data from the California Office of Statewide Health Planning and Development, which collects state mandated reports of ED visit data, were used in this study. Alcohol-related ED visits from the most recent data available (2006-2007) were estimated using Alcohol-Related Disease Impact (ARDI) software developed by the Centers for Disease Control and Prevention (CDC). Fifty-four alcohol-related diagnoses were analyzed by age, sex and ethnicity. The number of alcohol-related visits was calculated as the number of visits multiplied by the alcohol attributable fraction (AAF) for each diagnosis, which ranged from <0.10 for ischemic heart disease, stroke and several cancers to 1.0 for alcohol abuse and diagnoses specifically attributed to alcohol (eg, alcoholic liver cirrhosis).
Results
There were 17.3 million ED visits recorded for 2006-2007 in California with 4.8% (95% CI 4.80-4.83) being alcohol-related visits representing an estimated annual rate of 11.1/1000 population (95% CI 11.09-11.14). Of these, 81.3% were injury-related, 17% had an AAF = 1, and 1.7% were other diseases related to alcohol. Visits were highest in age 80+ with a rate of 21/1000 population (95% CI 20.8-21.2) primarily due to a high fall injury rate (90% of alcohol-related visits in this age group). Age 21-29 had the second highest rate of 18.1/1000 population (95% CI 18.0-18.2) primarily due to motor vehicle crashes (31% of alcohol-related visits in this age group). For all age ranges except 0-14, females had significantly higher alcohol-related visit rates than males for suicide attempt/self-inflicted injury. For all age ranges from 30-80+, females had significantly higher alcohol-related visit rates than males for fall injury. A diagnosis of alcohol abuse accounted for 13.1% of alcohol-related visits in whites, 13.3% for Latinos, 10.8% for blacks and 6.5% for Asians. Fall injuries were greatest in the white population (35.1% of alcohol-related visits), motor vehicle crashes for Asians were more than twice that for other ethnicities (30% of alcohol-related visits) and assault visits were most prevalent among the black population (19.2% of alcohol-related visits).
Conclusion
The majority of alcohol-related ED visits in California are associated with potentially preventable injuries. This reveals an important need and opportunity for broad integration of ED-based alcohol abuse prevention interventions including referral mechanisms for counseling and treatment. These preventive measures could offer improvement in the overall public health as well as lightening the burden on EDs to help maintain state-wide sustainability of emergency and acute care services.
Language: en |