10055The Ottawa Hospital Research Institute, Ontario, Canada.
Department of Family Medicine, University of Ottawa, Ontario, Canada.
Can J Psychiatry. 2022 Jul;67(7):534-543. doi: 10.1177/07067437211027321. Epub 2021 Jul 13.
While the overall health system burden of alcohol is large and increasing in Canada, little is known about how this burden differs by sociodemographic factors. The objectives of this study were to assess sociodemographic patterns and temporal trends in emergency department (ED) visits due to alcohol to identify emerging and at-risk subgroups.
We conducted a retrospective population-level cohort study of all individuals aged 10 to 105 living in Ontario, Canada. We identified ED visits due to alcohol between 2003 and 2017 using defined International Classification of Diseases, 10th edition, codes from a pre-existing indicator. We calculated annual age- and sex-standardized, and age- and sex-specific rates of ED visits and compared overall patterns and changes over time between urban and rural settings and income quintiles.
There were 829,662 ED visits due to alcohol over 15 years. Rates of ED visits due to alcohol were greater for individual living in the lowest- compared to the highest-income quintile neighbourhoods, and disparities (rate ratio lowest to highest quintile) increased with age from 1.22 (95% CI, 1.19 to 1.25) in 15- to 18-year-olds to 4.17 (95% CI, 4.07 to 4.28) in 55- to 59-year-olds. Rates of ED visits due to alcohol were significantly greater in rural settings (56.0 per 10,000 individuals, 95% CI, 55.7 to 56.4) compared to urban settings (44.8 per 10,000 individuals, 95% CI, 44.7 to 44.9), particularly for young adults. Increases in rates of visits between 2003 and 2017 were greater in rural versus urban settings (82 vs. 68% increase in age- and sex-standardized rates) and varied across sociodemographic subgroups with the largest annual increases in rates of visits in young (15 to 29) low-income women (6.9%, 95%CI, 6.7 to 7.3) and the smallest increase in older (45 to 59) high-income men (2.7, 95%CI, 2.4 to 3.0).
Alcohol harms display unique patterns with the highest burden in rural and lower-income populations. Rural-urban and income-based disparities differ by age and sex and have increased over time, which offers an imperative and opportunity for further interventions by clinicians and policy makers.
尽管加拿大的整体酒精卫生系统负担很大且呈上升趋势，但对于这种负担如何因社会人口因素而有所不同，人们知之甚少。本研究的目的是评估因酒精而导致的急诊部（ED）就诊的社会人口模式和时间趋势，以确定新兴和高危亚组。
我们对居住在加拿大安大略省的所有 10 至 105 岁人群进行了回顾性人群队列研究。我们使用预先存在的指标中定义的国际疾病分类第 10 版代码，确定了 2003 年至 2017 年间因酒精而导致的 ED 就诊情况。我们计算了每年按年龄和性别标准化的以及按年龄和性别划分的 ED 就诊率，并比较了城乡环境和收入五分位数之间的总体模式和随时间的变化。
在 15 年内，共有 829662 例因酒精导致的 ED 就诊。与收入最高的五分位组相比，生活在收入最低的五分位组的个体因酒精导致的 ED 就诊率更高，且差异（最低五分位比最高五分位的比率）随着年龄的增长而增加，从 15 至 18 岁的 1.22（95%CI，1.19 至 1.25）增加到 55 至 59 岁的 4.17（95%CI，4.07 至 4.28）。与城市环境相比（每 10000 人 44.8 例，95%CI，44.7 至 44.9），因酒精导致的 ED 就诊率在农村地区（每 10000 人 56.0 例，95%CI，55.7 至 56.4）显著更高，尤其是在年轻成年人中。2003 年至 2017 年间，农村地区的就诊率增长率高于城市地区（年龄和性别标准化就诊率分别增加 82%和 68%），且在社会人口亚组中存在差异，年轻（15 至 29 岁）低收入女性的就诊率增长率最大（6.9%，95%CI，6.7 至 7.3），而老年（45 至 59 岁）高收入男性的增长率最小（2.7%，95%CI，2.4 至 3.0）。
酒精危害呈现出独特的模式，在农村和低收入人群中负担最重。城乡和收入差异因年龄和性别而异，且随时间推移而增加，这为临床医生和政策制定者提供了进一步干预的必要性和机会。
