Bolton James M, Leong Christine, Ekuma Okechukwu, Prior Heather J, Konrad Geoffrey, Enns Jennifer, Singal Deepa, Nepon Josh, Paillé Michael T, Finlayson Greg, Nickel Nathan C
Department of Psychiatry (Bolton, Leong, Konrad, Nepon), Manitoba Centre for Health Policy (Bolton, Ekuma, Prior, Enns, Singal, Paillé, Finlayson, Nickel), College of Pharmacy (Leong) and Department of Community Health Sciences (Nickel), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.
CMAJ Open. 2020 Nov 24;8(4):E762-E771. doi: 10.9778/cmajo.20200124. Print 2020 Oct-Dec.
Alcohol is the drug most commonly used by Canadians, with multiple impacts on health and health service use. We examined patterns of short- and long-term health service use among people with a diagnosis of alcohol use disorder.
In this retrospective matched cohort study, we used population-based administrative data from the province of Manitoba, Canada, to identify individuals aged 12 years or older with a first indication of alcohol use disorder (index date) in the period 1990 to 2015. We matched cases (those with diagnosis of alcohol use disorder) to controls (those without this diagnosis), at a 1:5 ratio, on the basis of age, sex, geographic region and income quintile at the index date. The outcome measures were inpatient hospital admission, outpatient physician visits, emergency department visits and use of prescription medications. We modelled crude rates using generalized estimating equations with either a negative binomial or a Poisson distribution RESULTS: We identified 53 410 people with alcohol use disorder and 264 857 matched controls. All outcomes occurred at a higher rate among people with the disorder than among controls. For example, during the year of diagnosis, the rate ratio for hospital admission was 4.0 (95% confidence interval [CI] 3.9-4.2) for women and 4.5 (95% CI 4.4-4.7) for men. All rates of health service use peaked close to the index date, but remained significantly higher among people with alcohol use disorder than among controls for 20 years. Among people with alcohol use disorder, the most commonly filled prescriptions were for psycholeptics, whereas among controls, the most commonly filled prescriptions were for sex hormones (women) and antihypertensives (men).
Compared with controls, people with alcohol use disorder used significantly more health services from the time of diagnosis and over the next 20 years. This finding highlights the need for better detection and early intervention to reduce the need for acute and emergency care, as well as the need for improved management of alcohol use disorder over the longer term.
酒精是加拿大人最常用的药物，对健康和医疗服务使用有多重影响。我们研究了被诊断为酒精使用障碍者的短期和长期医疗服务使用模式。
在这项回顾性匹配队列研究中，我们使用了加拿大曼尼托巴省基于人群的行政数据，以识别1990年至2015年期间首次出现酒精使用障碍迹象（索引日期）的12岁及以上个体。我们根据索引日期的年龄、性别、地理区域和收入五分位数，以1:5的比例将病例（被诊断为酒精使用障碍者）与对照（未被诊断为此病者）进行匹配。结局指标为住院入院、门诊就诊、急诊就诊和处方药使用情况。我们使用广义估计方程，采用负二项分布或泊松分布对粗发病率进行建模。结果：我们识别出53410名酒精使用障碍患者和264857名匹配对照。所有结局在患有该障碍的人群中的发生率均高于对照人群。例如，在诊断当年，女性的住院率比为4.0（95%置信区间[CI]3.9 - 4.2），男性为4.5（95%CI 4.4 - 4.7）。所有医疗服务使用率在索引日期附近达到峰值，但在20年期间，酒精使用障碍患者的使用率仍显著高于对照人群。在酒精使用障碍患者中，最常开具的处方是抗精神病药物，而在对照人群中，最常开具的处方是性激素（女性）和抗高血压药物（男性）。
与对照相比，酒精使用障碍患者从诊断时起及之后20年使用的医疗服务显著更多。这一发现凸显了更好地进行检测和早期干预以减少急性和急诊护理需求的必要性，以及长期改善酒精使用障碍管理的必要性。
