John Ulrich, Rumpf Hans-Jürgen, Hanke Monika, Gerke Peter, Hapke Ulfert
University of Greifswald, Institute of Epidemiology and Social Medicine, D-17487 Greifswald, Germany.
Alcohol Alcohol. 2003 Jul-Aug;38(4):339-46. doi: 10.1093/alcalc/agg082.
The goal of this paper was to estimate and compare the numbers and rates of tobacco- or alcohol-attributable disease (TAAD) in in-patient-treated cases in a high tobacco smoking and alcohol consumption country, based on different estimates.
Two samples, three TAAD estimates, and tobacco- or alcohol-attributable fractions were used. Sample 1 included all disease cases aged 25-64 years and treated more than 24 h as in-patients during the year 1997 (n = 7 344 079) in the hospitals in Germany. Sample 2 included all in-patients aged 25-64 years (n = 1136) consecutively admitted to one general hospital. The first estimate of the TAAD was the routine main diagnosis based on the treating physician's report to the in-patient disease register (IDR) in sample 1. The second estimate included up to three routine treatment diagnoses in sample 2, and the third estimate a diagnosis of alcohol dependence or misuse according to DSM-III-R or ICD-10, as well as harmful or hazardous alcohol consumption, in sample 2. The tobacco- and alcohol-attributable fractions were calculated based on the method for the estimation of tobacco- and alcohol-attributable mortality, originally provided for the Centers for Disease Control in the USA.
When the three estimates were combined, a total of 37.8% of all in-patient treatment cases had at least one diagnosis that was attributable in part or fully to tobacco smoking, alcohol dependence, alcohol misuse, or harmful or hazardous alcohol drinking. When the tobacco- and the alcohol-attributable fractions were considered, of all treatment cases, 10.5% could be revealed as attributable to smoking or alcohol consumption according to the one main diagnosis based on the IDR. When all three estimates were combined, the rate was 30.2%. This corresponded to 32.2% of the national in-patient hospital care costs.
The TAAD rate is underestimated when using one routine diagnosis alone. Additional alcohol misuse or dependence diagnoses are needed, which may be obtained with a reasonable level of resources in a sample of hospitals. TAAD rates may be used for the planning and practice of brief intervention and as an outcome measure for population-based intervention.
本文旨在基于不同估算方法，对一个吸烟和饮酒率高的国家住院治疗病例中烟草或酒精所致疾病（TAAD）的数量和比率进行估算和比较。
采用了两个样本、三种TAAD估算方法以及烟草或酒精所致疾病比例。样本1包括1997年德国医院中所有年龄在25至64岁、住院时间超过24小时的疾病病例（n = 7344079）。样本2包括连续入住一家综合医院的所有年龄在25至64岁的住院患者（n = 1136）。TAAD的第一种估算方法是基于治疗医生向样本1中的住院疾病登记处（IDR）报告的常规主要诊断。第二种估算方法包括样本2中最多三种常规治疗诊断，第三种估算方法是根据DSM-III-R或ICD-10对样本2中的酒精依赖或滥用进行诊断，以及有害或危险饮酒诊断。烟草和酒精所致疾病比例是根据最初为美国疾病控制中心提供的烟草和酒精所致死亡率估算方法计算得出的。
当将这三种估算方法结合起来时，所有住院治疗病例中共有37.8%至少有一项诊断部分或完全归因于吸烟、酒精依赖、酒精滥用或有害或危险饮酒。当考虑烟草和酒精所致疾病比例时，根据基于IDR的一项主要诊断，所有治疗病例中有10.5%可归因于吸烟或饮酒。当将所有三种估算方法结合起来时，这一比率为30.2%。这相当于国家住院医院护理费用的32.2%。
仅使用一项常规诊断时，TAAD比率被低估。需要额外进行酒精滥用或依赖诊断，在医院样本中通过合理的资源水平可能获得这些诊断。TAAD比率可用于简短干预的规划和实践，并作为基于人群干预的结果指标。
