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Manthey J, Jacobsen B, Kilian C, Kraus L, Reimer J, Schäfer I, Schulte B. Alcohol-Specific Inpatient Diagnoses in Germany: A Retrospective Cross-Sectional Analysis of Primary and Secondary Diagnoses from 2012 to 2021. Addiction 2024. [PMID: 39039718 DOI: 10.1111/add.16625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/20/2024] [Indexed: 07/24/2024]
Abstract
AIMS Our study aimed to a) describe the distribution of hospital discharges with primary and secondary alcohol-specific diagnoses by sex and age group, and b) describe how the number of hospital discharges with primary and secondary alcohol-specific diagnoses have changed across different diagnostic groups (categorized by primary International Classification of Diseases, 10th Revision [ICD-10] diagnosis) over time. DESIGN Retrospective cross-sectional analysis. SETTING German hospital settings between 2012 and 2021. PARTICIPANTS All persons aged 15-69 admitted to hospitals as registered in a nationwide data set. MEASUREMENTS We counted a) the number of all hospital discharges and b) the number of hospital discharges with at least one alcohol-specific secondary diagnosis (secondary alcohol-specific diagnosis) by year, sex, age group, and diagnostic group. One diagnostic group included all primary alcohol-specific diagnoses, while 13 additional groups aligned with ICD-10 chapters (e.g., neoplasms). Alcohol-involvement was defined as either a primary or secondary alcohol-specific diagnosis. FINDINGS Of 95 417 204 recorded hospital discharges between 2012 and 2021, 3 828 917 discharges (4.0%; 2 913 903 men (6.4%); 915 014 women (1.8%)) involved either a primary or at least one secondary diagnosis related to alcohol. Of all alcohol-involved hospital discharges, 56.8% (1 654 736 discharges) had no primary but only a secondary alcohol-specific diagnosis. Secondary alcohol-specific diagnoses were particularly prevalent in hospital discharges due to injuries. With rising age, alcohol-involvement in hospital discharges due to digestive or cardiovascular diseases increased. Between 2012 and 2021, the rate of alcohol-involved hospital discharges has decreased more in younger as compared with older adults (average change between 2012 and 2021: 15-24: -55%; 25-34: -41%; 35-44: -23%; 45-54: -31%; 55-64: -21%; 65-69: -8%). CONCLUSIONS The number of alcohol-involved hospital discharges in Germany from 2012 to 2021 more than doubles (from 1 654 736 to 3 828 917) when including secondary alcohol-specific diagnoses. More pronounced declines among younger adults may be attributed to unequal changes in alcohol consumption patterns across the population and to the hazardous effects of long-term alcohol use.
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Affiliation(s)
- Jakob Manthey
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Britta Jacobsen
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carolin Kilian
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Ludwig Kraus
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Jens Reimer
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Psychosocial Medicine, Itzehoe Clinic, Itzehoe, Germany
| | - Ingo Schäfer
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Schulte
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Kilian C, Manthey J, Probst C. Quantifying alcohol's harm to others: a research and policy proposal. Bull World Health Organ 2024; 102:448-452. [PMID: 38812799 PMCID: PMC11132158 DOI: 10.2471/blt.24.291338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/05/2024] [Accepted: 04/17/2024] [Indexed: 05/31/2024] Open
Abstract
Just under 2.5 million people die annually due to alcohol use. This global estimate, however, excludes most of the health burden borne by others than the alcohol user. Alcohol's harm to others includes a multitude of conditions, such as trauma from traffic crashes, fetal disorders due to prenatal exposure to alcohol, as well as interpersonal and intimate partner violence. While alcohol's causal role in these conditions is well-established, alcohol's harm to others' contribution to the overall health burden of alcohol remains unknown. This knowledge gap leads to a situation in which alcohol policy and prevention strategies largely focus on the reduction of alcohol's detrimental health harms on the alcohol users, neglecting affected others and population groups most vulnerable to these harms, including women and children. In this article, we seek to elucidate why estimates for alcohol's harm to others are lacking and offer guidance for future research. We also argue that a full assessment of the alcohol health burden that includes the harm caused by others' alcohol use would enhance the visibility and public awareness of such harms, and advancing the evaluation of policy interventions to mitigate them.
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Affiliation(s)
- Carolin Kilian
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
| | - Jakob Manthey
- Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
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Bhagavathula AS, Aldhaleei WA. Alcohol and Substance Use Among the Working Age Population: A Nationwide Study of Fall-Related Emergency Department Visits. J Stud Alcohol Drugs 2024; 85:330-338. [PMID: 38270911 PMCID: PMC11218450 DOI: 10.15288/jsad.23-00330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/13/2024] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVE Prior studies have linked fall-related emergency department (ED) visits among older adults to alcohol use. Characteristics related to falls in the working age population (WAP; 15-64 years) may vary with alcohol and substance use. This study aimed to identify factors associated with fall-related ED visits related to alcohol and substance use in the WAP. METHOD Using nationally representative 2019-2020 National Hospital Ambulatory Medical Care Survey data, fall-related ED visits within 72 hours were stratified by indication of alcohol use, substance use, and concurrent alcohol and substance use. Descriptive statistics accounting for the survey's complex design were used along with multivariable logistic regression to identify associated factors. RESULTS Between 2019 and 2020, an estimated 10,800,000 fall-related ED visits occurred among the WAP, with 51.7% related to alcohol use, substance use, or both. Multivariable logistic regression analysis revealed that the WAP with fall-injury ED visits were associated with alcohol use (adjusted odds ratio [AOR] = 2.3, 95% CI [1.0, 5.9]) or concurrent alcohol and substance use (AOR = 8.5, 95% CI [1.6, 43.0]), and individuals with alcohol and substance use with a depression diagnosis are twice as likely to visit EDs with fall injuries. CONCLUSIONS Individuals with alcohol and substance use with depression were twice as likely to visit EDs for fall injuries. Higher fall-related ED visits in the WAP were attributed to alcohol and substance use. Identified factors could improve injury prevention and timely intervention among the WAP in the United States.
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Affiliation(s)
- Akshaya Srikanth Bhagavathula
- Department of Public Health, College of Health and Human Services, North Dakota State University, Fargo, North Dakota
| | - Wafa A. Aldhaleei
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
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Jørgenrud BM, Bråthen CC, Steinson Stenehjem J, Kristiansen T, Rosseland LA, Bogstrand ST. Identifying excessive chronic alcohol use with phosphatidylethanol in patients with suspected severe injury-results from the IDART study. Alcohol Alcohol 2024; 59:agae014. [PMID: 38497164 PMCID: PMC10945293 DOI: 10.1093/alcalc/agae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/02/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION Acute and chronic alcohol use are well-known risk factors for accidents and injuries, and concurrent psychoactive drug use can increase injury risk further. Phosphatidylethanol (PEth) 16:0/18:1 is a biomarker used to determine alcohol consumption the previous 3-4 weeks. The aim was to investigate the prevalence of chronic alcohol use in trauma patients, as determined by PEth 16:0/18:1 concentrations, and how excessive chronic alcohol use relate to demographic variables, injury mechanisms and drug use. SETTING Patients received at Norwegian trauma hospitals from March 2019 to February 2020. The study is part of the Impairing Drugs and Alcohol as Risk factors for Traumatic Injuries study. METHODS All patients aged ≥ 16 years received with trauma team were included in the study. Data on injury date and mechanism, gender and age was registered. Blood samples were analyzed for 22 psychoactive medicinal and illicit drugs, ethanol and phosphatidylethanol 16:0/18:1. Regression analyses were conducted to assess associations between alcohol use and gender, age, injury mechanism and drug use. RESULTS AND CONCLUSION Of the 4845 patients included in the study, 10% had PEth 16:0/18:1 concentration ≥ 600 nM (~430 ng/mL), indicative of excessive chronic alcohol use. Being male, between 44-61 years old, involved in violence, and testing positive for medicinal drugs was associated with excessive chronic alcohol use.Excessive chronic alcohol use was common among males, middle-aged, patients with violence as injury mechanism and those with medicinal drug use. These findings emphasize the need to detect and treat excessive chronic alcohol use among trauma patients.
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Affiliation(s)
- Benedicte M Jørgenrud
- Section of Drug Abuse Research, Department of Forensic Science, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Camilla C Bråthen
- Division of Elverum-Hamar, Department of Acute Medicine, Innlandet Hospital Trust, P.O. Box 104, N-2381 Brumunddal, Norway
- Institute of Clinical Medicine, Department of Anesthesia and Intensive Care medicine, University of Oslo, P.O. Box 1171 Blindern, 0318 Oslo, Norway
| | - Jo Steinson Stenehjem
- Institute of Clinical Medicine, Department of Anesthesia and Intensive Care medicine, University of Oslo, P.O. Box 1171 Blindern, 0318 Oslo, Norway
| | - Thomas Kristiansen
- Institute of Clinical Medicine, Department of Anesthesia and Intensive Care medicine, University of Oslo, P.O. Box 1171 Blindern, 0318 Oslo, Norway
- Division of Emergencies and Critical Care, Department of Anaesthesiology, Oslo University Hospital, P.O. Box 4950, N-0424 Oslo, Norway
| | - Leiv Arne Rosseland
- Institute of Clinical Medicine, Department of Anesthesia and Intensive Care medicine, University of Oslo, P.O. Box 1171 Blindern, 0318 Oslo, Norway
- Division of Emergencies and Critical Care, Department of Research & Development, Oslo University Hospital, P.O. Box 4950, N-0424 Oslo, Norway
| | - Stig Tore Bogstrand
- Section of Drug Abuse Research, Department of Forensic Science, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Acute and Critical Illness, Oslo Metropolitan University, P.O. Box 4 St Olavs plass, N-0130 Oslo, Norway
- Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1089 Blindern, 0318 Oslo, Norway
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Tian Y, Liu J, Zhao Y, Jiang N, Liu X, Zhao G, Wang X. Alcohol consumption and all-cause and cause-specific mortality among US adults: prospective cohort study. BMC Med 2023; 21:208. [PMID: 37286970 DOI: 10.1186/s12916-023-02907-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Previous studies have shown inconsistent findings regarding the association of light to moderate alcohol consumption with cause-specific mortality. Therefore, this study sought to examine the prospective association of alcohol consumption with all-cause and cause-specific mortality in the US population. METHODS This was a population-based cohort study of adults aged 18 years or older in the National Health Interview Survey (1997 to 2014) with linkage to the National Death Index records through December 31, 2019. Self-reported alcohol consumption was categorized into seven groups (lifetime abstainers; former infrequent or regular drinkers; and current infrequent, light, moderate, or heavy drinkers). The main outcome was all-cause and cause-specific mortality. RESULTS During an average follow-up of 12.65 years, among the 918,529 participants (mean age 46.1 years; 48.0% male), 141,512 adults died from all causes, 43,979 from cardiovascular disease (CVD), 33,222 from cancer, 8246 from chronic lower respiratory tract diseases, 5572 from accidents (unintentional injuries), 4776 from Alzheimer's disease, 4845 from diabetes mellitus, 2815 from influenza and pneumonia, and 2692 from nephritis, nephrotic syndrome, or nephrosis. Compared with lifetime abstainers, current infrequent, light, or moderate drinkers were at a lower risk of mortality from all causes [infrequent-hazard ratio: 0.87; 95% confidence interval: 0.84 to 0.90; light: 0.77; 0.75 to 0.79; moderate 0.82; 0.80 to 0.85], CVD, chronic lower respiratory tract diseases, Alzheimer's disease, and influenza and pneumonia. Also, light or moderate drinkers were associated with lower risk of mortality from diabetes mellitus and nephritis, nephrotic syndrome, or nephrosis. In contrast, heavy drinkers had a significantly higher risk of mortality from all causes, cancer, and accidents (unintentional injuries). Furthermore, binge drinking ≥ 1 day/week was associated with a higher risk of mortality from all causes (1.15; 1.09 to 1.22), cancer (1.22; 1.10 to 1.35), and accidents (unintentional injuries) (1.39; 1.11 to 1.74). CONCLUSIONS Infrequent, light, and moderate alcohol consumption were inversely associated with mortality from all causes, CVD, chronic lower respiratory tract diseases, Alzheimer's disease, and influenza and pneumonia. Light or moderate alcohol consumption might also have a beneficial effect on mortality from diabetes mellitus and nephritis, nephrotic syndrome, or nephrosis. However, heavy or binge had a higher risk of all-cause, cancer, and accidents (unintentional injuries) mortality.
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Affiliation(s)
- Yalan Tian
- Department of Maternal and Child Health, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, China
| | - Jiahui Liu
- Department of Maternal and Child Health, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, China
| | - Yue Zhao
- Department of Maternal and Child Health, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, China
| | - Nana Jiang
- Department of Maternal and Child Health, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, China
| | - Xiao Liu
- Department of Maternal and Child Health, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, China
| | - Gang Zhao
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xia Wang
- Department of Maternal and Child Health, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, China.
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Social Determinants of Seeking and Reaching Injury Care in South Africa: A Community-Based Qualitative Study. Ann Glob Health 2023; 89:5. [PMID: 36743285 PMCID: PMC9881434 DOI: 10.5334/aogh.4003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/16/2022] [Indexed: 01/28/2023] Open
Abstract
Background Timely access to quality injury care saves lives and prevents disabilities. The impact of social determinants of health on the high injury prevalence in South Africa is well documented, however, evidence of their role in accessing injury care is lacking. This study explored the social determinants of seeking and reaching injury care in South Africa. Methods This was a qualitative study involving rural and urban patients, community members, and healthcare providers in Western Cape, South Africa. Data were obtained through semi-structured interviews and focus group discussions using an interview guide informed by the four-delays framework. Inductive and deductive approaches were used for thematic analysis. Results A total of 20 individual interviews and 5 focus group discussions were conducted. There were 28 males (individual interviews: 13; focus groups: 15) and 22 females (individual interviews: 7; focus groups: 15), and their mean age was 41 (standard deviation ±15) years. Barriers to seeking and reaching injury care cut across five social determinants of health domains: healthcare access and quality; neighbourhood and environment; social and community context; education; and economic stability. The most prominent social determinants of seeking and reaching injury care were related to healthcare access and quality, including perceived poor healthcare quality, poor attitude of healthcare workers, long waiting time, and ambulance delays. However, there was a strong interconnection between these and neighbourhood and environmental determinants such as safety concerns, high crime rates, gangsterism, lack of public transportation, and social and community factors (presence/absence of social support and alcohol use). Barriers related to education and economic stability were less prevalent. Conclusion We found a substantial role of neighbourhood, social, and community factors in seeking and reaching injury care. Therefore, efforts aimed at improving access to injury care and outcomes must go beyond addressing healthcare factors to include other social determinants and should involve collaborations with multiple sectors, including the community, the police, the transport department, and alcohol regulation agencies.
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Rajalu BM, Indira Devi B, Shukla DP, Shukla L, Jayan M, Prasad K, Jayarajan D, Kandasamy A, Murthy P. Traumatic brain injury during COVID-19 pandemic-time-series analysis of a natural experiment. BMJ Open 2022; 12:e052639. [PMID: 35396279 PMCID: PMC8995573 DOI: 10.1136/bmjopen-2021-052639] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study aims to find if the incidence and pattern of traumatic brain injury (TBI) changed during the COVID-19pandemic. We also aim to build an explanatory model for change in TBI incidence using Google community mobility and alcohol sales data. DESIGN A retrospective time-series analysis. SETTING Emergency department of a tertiary level hospital located in a metropolitan city of southern India. This centre is dedicated to neurological, neurosurgical and psychiatric care. PARTICIPANTS Daily counts of TBI patients seen between 1 December 2019 and 3 January 2021 (400 days); n=8893. To compare the profile of TBI cases seen before and during the pandemic, a subset of these cases seen between 1 December 2019 and 31 July 2020 (244 days), n=5259, are studied in detail. RESULTS An optimal changepoint is detected on 20 March 2020 following which the mean number of TBI cases seen every day has decreased and variance has increased (mean 1=29.4, variance 1=50.1; mean 2=19.5, variance 2=59.7, loglikelihood ratio test: χ2=130, df=1, p<0.001). Two principal components of community mobility, alcohol sales and weekday explain the change in the number of TBI cases (pseudo R2=58.1). A significant decrease in traffic accidents, falls, mild/moderate injuries and, an increase in assault and severe injuries is seen during the pandemic period. CONCLUSIONS Decongestion of roads and regulation of alcohol sales can decrease TBI occurrence substantially. An increase in violent trauma during lockdown needs further research in the light of domestic violence. Acute care facilities for TBI should be maintained even during a strict lockdown as the proportion of severe TBI requiring admission increases.
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Affiliation(s)
- Banu Manickam Rajalu
- Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Bhagavatula Indira Devi
- Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
- Collaborator in National Institute for Health Research Global Health Research Group on Neurotrauma (NIHRGHRGNT), National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Dhaval P Shukla
- Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Lekhansh Shukla
- Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Mini Jayan
- Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Krishna Prasad
- Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Deepak Jayarajan
- Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Arun Kandasamy
- Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Pratima Murthy
- Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
- Director, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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van Hoving DJ, van Koningsbruggen C, de Man M, Hendrikse C. Temporal changes in trauma according to alcohol sale restrictions during the South African national COVID-19 lockdown. Afr J Emerg Med 2021; 11:477-482. [PMID: 34490069 PMCID: PMC8410509 DOI: 10.1016/j.afjem.2021.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/26/2021] [Accepted: 08/15/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction The South African government enforced various alcohol sale restrictions during the COVID-19 lockdown in order to reduce hospital admissions related to alcohol-associated injuries. A cross-sectional study was performed to describe the temporal changes in trauma according to alcohol sale restrictions during the South African national COVID-19 lockdown. Methods Data from all trauma-related patients presenting to the emergency centre of Mitchells Plain Hospital from 01/03/2020 till 29/9/2020 and corresponding periods during 2019 were exported from an existing database. The relationship between variables was determined with the χ2-test, Fisher's exact test, independent samples median test or t-test. A sub-analysis compared similar 2020 lockdown levels when a second alcohol ban were instituted while most business were allowed to operate (level 3b – alcohol banned versus level 3 – alcohol restricted). Results Total number of trauma presentations were 539 (14.6%) less in 2020 (n = 3160) than in 2019 (n = 3699); the mean number decreased by 2.5 per day (95% CI −2.9 to −2.1). Lockdown levels with an alcohol ban had on average 4.8 less patients per day than corresponding periods in 2019 (p < 0.001). No significant difference was observed in lockdown levels with alcohol sale restrictions (mean difference per day −0.4, p = 0.195). Trauma presentations increased significantly (mean difference per day 7.0 (95% CI 6.5 to 7.5)) from 2020 lockdown levels with alcohol sales ban (mean per day 11.4) to 2020 lockdown levels with alcohol sale restrictions (mean per day 18.4). Significantly less patients (mean −3.2 (95% CI −3.9 to −2.5)) presented during 2020 lockdown level 3b (alcohol sales banned, mean 13.9) compared to level 3 (alcohol sales restricted, mean 17.1). Conclusion Temporal changes in trauma were observed according to alcohol sale restrictions during South Africa's COVID-19 lockdown periods. Significantly less trauma cases presented during periods with an alcohol ban compared to periods where alcohol sales were only restricted.
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Affiliation(s)
- Daniel J. van Hoving
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Corresponding author.
| | - Candice van Koningsbruggen
- Mitchells Plain Hospital and Heideveld Hospital Emergency Centres, Cape Town, South Africa
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Martin de Man
- Mitchells Plain Hospital and Heideveld Hospital Emergency Centres, Cape Town, South Africa
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Clint Hendrikse
- Mitchells Plain Hospital and Heideveld Hospital Emergency Centres, Cape Town, South Africa
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
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Ye Y, Cherpitel CJ, Terza JV, Kerr WC. Quantifying risk of injury from usual alcohol consumption: An instrumental variable analysis. Alcohol Clin Exp Res 2021; 45:2029-2039. [PMID: 34342011 PMCID: PMC8602733 DOI: 10.1111/acer.14684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/28/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Numerous studies of roadside accidents among emergency room patients show elevated risk of injury from acute alcohol consumption, i.e., recent drinking precedes the injury event. The observed effects are large and show a dose-response relationship. In contrast, studies quantifying the association between injury risk and chronic consumption, such as past-year average volume, show lower relative risk estimates than those from acute consumption. METHODS Combining data from 4 waves of US National Alcohol Surveys (NAS) for years 2000-2015 (N = 29,571, 53% overall cooperation rate), we estimated the risk of any past-year injury from past-year volume using logistic regression. This was contrasted with an instrumental variable (IV) analysis utilizing a 2-stage residual inclusion (2SRI) approach to estimate injury risk from volume, which adjusted for unobserved confounders using state beer and spirits tax rates, zip code-level outlet and bar density, and control state status as instruments. RESULTS Based on the combined US population surveys and controlling for sociodemographics, using conventional logistic regression, the odds ratios of injury from an average volume of 1, 2, and 5 drinks per day were 1.12 [95% confidence interval: 1.02, 1.24], 1.10 [1.00, 1.22], and 1.04 [0.88, 1.22], respectively. These compared with 1.67 [1.00, 2.78], 2.38 [0.87, 6.54], and 6.98 [0.57, 85.89] using the IV method. The proportion of injury attributed to alcohol also increased in magnitude, from 6.2% [0.3%, 11.9%] using the conventional approach to 17.9% [8.2%, 27.7%] using the IV method. CONCLUSIONS The association between injury and chronic alcohol consumption may be confounded by unobserved factors, resulting in a possible downward bias of the risk estimate.
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Affiliation(s)
- Yu Ye
- Alcohol Research Group, Public Health Institute, Emeryville, CA
| | | | - Joseph V. Terza
- Department of Economics, Indiana University School of Liberal Arts at IUPUI
| | - William C. Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, CA
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Chikritzhs T, Livingston M. Alcohol and the Risk of Injury. Nutrients 2021; 13:2777. [PMID: 34444939 PMCID: PMC8401155 DOI: 10.3390/nu13082777] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 12/14/2022] Open
Abstract
Globally, almost four and a half million people died from injury in 2019. Alcohol's contribution to injury-related premature loss of life, disability and ill-health is pervasive, touching individuals, families and societies throughout the world. We conducted a review of research evidence for alcohol's causal role in injury by focusing on previously published systematic reviews, meta-analyses and where indicated, key studies. The review summarises evidence for pharmacological and physiological effects that support postulated causal pathways, highlights findings and knowledge gaps relevant to specific forms of injury (i.e., violence, suicide and self-harm, road injury, falls, burns, workplace injuries) and lays out options for evidence-based prevention.
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Affiliation(s)
- Tanya Chikritzhs
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6008, Australia;
| | - Michael Livingston
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6008, Australia;
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia
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Chu KM, Marco JL, Owolabi EO, Duvenage R, Londani M, Lombard C, Parry CDH. Trauma trends during COVID-19 alcohol prohibition at a South African regional hospital. Drug Alcohol Rev 2021; 41:13-19. [PMID: 33998731 PMCID: PMC8239859 DOI: 10.1111/dar.13310] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/21/2021] [Accepted: 04/25/2021] [Indexed: 11/28/2022]
Abstract
Introduction The objective of this study was to examine the relationship between trauma volume and alcohol prohibition during the COVID‐19 lockdown in South Africa. Methods This was a retrospective analysis of trauma volume from Worcester Regional Hospital in South Africa from 1 January to 28 December 2020. We compared total volume and incidence rates during five calendar periods; one when alcohol sales were allowed as per normal and four when alcohol sales were completely or partially banned. Poisson regression was used to model differences between alcohol ban and non‐ban periods. Results During the first period (pre‐COVID‐19, no ban), the trauma admission rate was 95 per 100 days, compared to 39 during the second period (complete ban 1), 74 during the third period (partial ban 1), 40 during the fourth period (complete ban 2) and 105 during the fifth period (partial ban 2). There was a 59–69% decrease in trauma volume between the no ban and complete ban 1 periods. When alcohol sales were partially reinstated, trauma volume significantly increased by 83–90% then dropped again by 39–46% with complete ban 2. By the second half of 2020, when alcohol sales were partially allowed again (partial ban 2), trauma volume increased by 163–250%, thus returning to pre‐COVID‐19 levels. Discussion and Conclusions Our study demonstrates a clear trend of decreased trauma volume during periods of complete alcohol prohibition compared to non‐ and partial alcohol bans. This finding suggests that temporary alcohol bans can be used to decrease health facility traffic during national emergencies.
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Affiliation(s)
- Kathryn M Chu
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Jenna-Lee Marco
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Eyitayo Omolara Owolabi
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Riaan Duvenage
- Department of Surgery, Worcester Regional Hospital, Worcester, South Africa.,Ukwanda Centre for Rural Health, Stellenbosch University, Tygerberg, South Africa
| | - Mukhethwa Londani
- Alcohol Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Tygerberg, South Africa.,Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Charles D H Parry
- Alcohol Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa.,Department of Psychiatry, Stellenbosch University, Tygerberg, South Africa
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Parry CDH. A timely piece that resonates with the South African experience: Commentary on Stockwell et al. Drug Alcohol Rev 2020; 40:8-9. [PMID: 33029822 DOI: 10.1111/dar.13159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 11/28/2022]
Abstract
The authors correctly conclude that the burden from alcohol in Canada is substantially greater than it is from COVID-19, and thus, alcohol should be given more attention. However, they fail to mention that in some countries, with the rise in COVID-19-related hospital admissions, competition can occur between COVID-19 and trauma patients for scarce hospital resources. In South Africa, this has led to the temporary banning of alcohol sales at two periods during the lockdown. Stockwell et al. highlight the fact that alcohol is deemed an 'essential service' in many countries and point to the reasons why this might have occurred, and that industry appears to be taking advantage of lockdown conditions to expand their reach in ways that might continue after the lockdown. The alcohol industry in South Africa has also used the points given by Stockwell et al. as to why governments might be reluctant to restrict alcohol at this time in pushing back against imposition of alcohol control measures, and furthermore referred to the effect of the sales ban on jobs in the alcohol and related industries and policy inconsistencies in dealing with different industries. Finally, the commentary expands on the measures presented on how governments should use the opportunity provided by the COVID-19 crisis to push for further alcohol control measures to be implemented.
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Affiliation(s)
- Charles D H Parry
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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Ye Y, Cherpitel CJ, Witbrodt J, Andreuccetti G, Room R. The interactive effect of location, alcohol consumption and non-traffic injury. Addiction 2020; 115:1640-1649. [PMID: 32003080 PMCID: PMC7390699 DOI: 10.1111/add.14992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/18/2019] [Accepted: 01/24/2020] [Indexed: 12/13/2022]
Abstract
AIM This study aimed to assess the extent to which the association between recent alcohol consumption and risk of non-traffic injury varies according to location at the time of the injury. DESIGN Case-cross-over design. SETTING AND PARTICIPANTS A total of 15 625 injury patients from 49 emergency departments (EDs) in 22 countries. MEASUREMENTS Recent alcohol consumption and location at the time of the injury were assessed for when the injury occurred and for the same time 1 week prior to this. The confounding and interactive effects of location were examined by estimating the adjusted odds ratio (OR) of injury from alcohol consumption adjusting for location and then by examining the alcohol consumption × location interaction. FINDINGS There were significant interactive effects of location and alcohol consumption on injury risk. For example, the ORs for volume 0.1-3.0 drinks and street/public place each were 3.0 and 14.2, respectively, whereas the OR for their joint effect was 44.1, suggesting a positive additive interaction [relative excess risk due to interaction (RERI) = 27.9, P < 0.05] and zero multiplicative interaction (OR = 1.0, P = 0.895). The interactions of alcohol consumption with drinking establishment location, work-place and other locations were mostly additive and negative on the multiplicative scale (e.g. for interaction between volume 0.1-3.0 drinks and drinking establishment location: RERI = 1.19, P = 0.529; multiplicative interaction OR = 0.54, P < 0.05). CONCLUSIONS Location appears to influence the relationship between alcohol consumption and risk of injury. The association between alcohol consumption and injury appears to be greater in locations such as streets and public places compared with private residences.
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Affiliation(s)
- Yu Ye
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | | | - Jane Witbrodt
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | | | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia,Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
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Stockwell T, Andreasson S, Cherpitel C, Chikritzhs T, Dangardt F, Holder H, Naimi T, Sherk A. The burden of alcohol on health care during COVID-19. Drug Alcohol Rev 2020; 40:3-7. [PMID: 32835427 PMCID: PMC7461236 DOI: 10.1111/dar.13143] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 01/07/2023]
Abstract
Alcohol's impact on global health is substantial and of a similar order of magnitude to that from COVID‐19. Alcohol now also poses specific concerns, such as increased risk of severe lung infections, domestic violence, child abuse, depression and suicide. Its use is unlikely to aid physical distancing or other preventative behavioural measures. Globally, alcohol contributes to 20% of injury and 11.5% of non‐injury emergency room presentations. We provide some broad comparisons between alcohol‐attributable and COVID‐19‐related hospitalisations and deaths in North America using most recent data. For example, for Canada in 2017 it was recently estimated there were 105 065 alcohol‐attributable hospitalisations which represent a substantially higher rate over time than the 10 521 COVID‐19 hospitalisations reported during the first 5 months of the pandemic. Despite the current importance of protecting health‐care services, most governments have deemed alcohol sales to be as essential as food, fuel and pharmaceuticals. In many countries, alcohol is now more readily available and affordable than ever before, a situation global alcohol producers benefit from and have helped engineer. We argue that to protect frontline health‐care services and public health more generally, it is essential that modest, evidence‐based restrictions on alcohol prices, availability and marketing are introduced. In particular, we recommend increases in excise taxation coupled with minimum unit pricing to both reduce impacts on health‐care services and provide much‐needed revenues for governments at this critical time.
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Affiliation(s)
- Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada.,Department of Psychology, University of Victoria, Victoria, Canada
| | - Sven Andreasson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Tanya Chikritzhs
- National Drug Research Institute, Health Sciences, Curtin University, Perth, Australia
| | - Frida Dangardt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Harold Holder
- Pacific Institute for Research and Evaluation, Prevention Research Center, Calverton, USA
| | - Timothy Naimi
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Adam Sherk
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
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