Rates of emergency department visits attributable to alcohol use in Ontario from 2003 to 2016: a retrospective population-level study

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Figure 1:
Cross-sectional trends (years 2003, 2007, 2011 and 2016) depicting the unadjusted rates of emergency department (ED) visits attributable to alcohol, in 5-year age increments for men and women.

Table 1:

Characteristics of Ontario residents who visited the emergency department because of alcohol use, 2003–2016 (n = 480 611)

Characteristic	No. (%) of patients^*		Standardized difference
Characteristic	Women n = 170 225	Men n = 310 386	Standardized difference
No. of visits attributable to alcohol use (% of total visits), n = 765 346	247 044 (32.3)	518 302 (67.7)	–
No. of visits in year of initial visit, mean ± SD	1.45 ± 2.05	1.67 ± 3.32	0.80
1 visit	141 481 (83.1)	246 752 (79.5)	0.09
2 visits	15 971 (9.4)	32 940 (10.6)	0.04
3 visits	5234 (3.1)	11 681 (3.8)	0.04
4 visits	2425 (1.4)	5711 (1.8)	0.03
≥ 5 visits	5114 (3.0)	13 302 (4.3)	0.07
Age, yr^†
Age, mean ± SD	36.42 ± 17.79	41.09 ± 17.31	0.27
10–18	29 646 (17.4)	28 315 (9.1)	0.25
19–24	33 312 (19.6)	47 220 (15.2)	0.12
25–40	38 398 (22.6)	74 084 (23.9)	0.03
41–64	56 003 (32.9)	130 635 (42.1)	0.19
65–80	10 799 (6.3)	26 811 (8.6)	0.09
> 80	2067 (1.2)	3321 (1.1)	0.01
Income quintile
1 (lowest)	48 754 (28.6)	95 616 (30.8)	0.05
2	33 115 (19.5)	63 896 (20.6)	0.03
3	29 115 (17.1)	54 271 (17.5)	0.01
4	28 130 (16.5)	47 917 (15.4)	0.03
5 (highest)	28 867 (17.0)	43 932 (14.2)	0.08
Population centre and rural area classification
Large urban population centre (≥ 100 000)	110 660 (65.0)	207 245 (66.8)	0.01
Medium population centre (30 000–99 999)	16 170 (9.5)	27 476 (8.9)	0.02
Small population centre (1000–29 999)	18 600 (10.9)	31 815 (10.3)	0.04
Rural population centre (< 1000)	24 731 (14.5)	43 797 (14.1)	0.01

Table 2:

Changes in number of visits to the emergency department attributable to alcohol use by diagnostic codes, 2003–2016

ICD-10 code^*	No. of visits			Absolute % increase^†
ICD-10 code^*	All years	2003	2016	Absolute % increase^†
Mental health harms
Acute intoxication (F100)	363 566	18 341	34 276	86.9
Harmful use (F101)	174 942	9376	17 979	91.8
Alcohol dependence (F102)	89 118	6496	6737	3.7
Alcohol withdrawal (F103, F104)	93 332	4282	11 010	178.2
Mental and behavioural disorders due to use of alcohol, other, i.e., psychosis, amnesic syndrome (F105–F109)	8846	380	1313	245.5
Medical harms
Alcoholic liver disease (K700–K704, K709)	23 192	1063	2,452	130.7
Alcoholic gastritis (K292)	11 799	771	976	26.6
Accidental or intentional poisoning by alcohol (X45, Y15, X65)	21 532	1187	1898	59.9
Other medical conditions due to alcohol, i.e., alcohol induced: acute pancreatitis, neuropathy, cardiomyopathy (G312, G621, G721, I426, K852, K860, E244, T510, T519, R780)	28 618	1753	2775	58.3
Maternal care for (suspected) damage to fetus from alcohol/Fetal alcohol syndrome (Q99304, Q99305, Q860, P043)	878	6	134	2133.3
Total	815 823^‡	43 655	79 550	82.2

Note: ICD-10 = International Classification of Diseases, 10th Revision.
↵* See Appendix 1, Supplementary Table 1 (available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.181575/-/DC1) for the full description of the ICD-10 codes in the indicator.
↵† See Appendix 1, Supplementary Table 2 for an analysis of the annual percentage increase in rates of ICD-10 codes accounting for changes in population demographics.
↵‡ Total number of codes exceeds the total number of emergency department visits because some visits were considered to be caused by more than 1 alcohol-related harm and therefore were assigned more than 1 ICD-10 code.

Table 3:

Temporal trends in emergency department visits attributable to alcohol use and all-cause emergency department visits, 2003–2016

Characteristic	Women			Men

	2003	2016	Absolute % increase	2003	2016	Absolute % increase
No. of all-cause visits	2 010 480	2 836 984	41.1^*	1 878 141	2 430 534	29.4^*

No. of visits attributable to alcohol	11 868	24 951	110.2^*	27 962	49 669	77.6^*

No. of individuals who visited because of alcohol use	8823	15 408	75.6^*	17 167	27 348	59.3^*

No. of visits attributable to alcohol per year in individuals with an initial visit, mean (95% CI)	1.35 (1.32–1.37)	1.62 (1.59–1.67)	20.9^†	1.63 (1.58–1.66)	1.82 (1.78–1.86)	11.7^†

Age-standardized rate of all-cause visits (per 10 000 population)	3599.73	4312.52	19.8	3506.14	3806.97	8.6

Age-standardized rate of visits attributable to alcohol (per 10 000 population)	20.71	38.62	86.5	51.12	78.31	53.2

Proportion of all visits attributable to alcohol	0.59%	0.88%	49.1	1.49%	2.04%	36.9

Note: CI = confidence interval.
↵* p < 0.001 χ² test comparing change between 2003 and 2016 for men and for women.
↵† p < 0.001 t test on difference in averages between 2003 and 2016 for men and for women.