Assessment of Age and Sex Differences in Risk of 1-Year Mortality After Emergency Department Visits Caused by Alcohol Use

This cross-sectional study assesses age and sex differences in risk of 1-year mortality in patients with emergency department visits due to alcohol compared with the general population in Ontario, Canada.


Case Definitions
The primary outcome was all-cause mortality in the year following on or more Emergency Department (ED) visits due to alcohol. ED visits due to alcohol were defined as visits where one of the ICD-10 codes from Table 1 was listed as the main or contributing reason for the ED visit. Table 1. ICD-10 codes for ED visits due to alcohol ICD Code Type of Harm F100 Mental and behavioural disorders due to use of alcohol, acute intoxication F101 Mental and behavioural disorders due to use of alcohol, harmful use F102 Mental and behavioural disorders due to use of alcohol, dependence syndrome F103 Mental and behavioural disorders due to use of alcohol, withdrawal state F104 Mental and behavioural disorders due to use of alcohol, withdrawal state with delirium F105 Mental and behavioural disorders due to use of alcohol, psychotic disorder F106 Mental and behavioural disorders due to use of alcohol, amnesic syndrome F107 Mental and behavioural disorders due to use of alcohol, residual and late-onset psychotic disorder F108 Mental and behavioural disorders due to use of alcohol, other mental and behavioural disorders F109 Mental and behavioural disorders due to use of alcohol, unspecified mental and behavioural disorder E244 Alcohol-induced pseudo-Cushing's syndrome G312 Degeneration of nervous system due to alcohol G621 Alcoholic polyneuropathy G721 Alcoholic myopathy I426 Alcoholic cardiomyopathy K292 Alcoholic gastritis K700 Alcoholic fatty liver K701 Alcoholic hepatitis K702 Alcoholic fibrosis and sclerosis of liver K703 Alcoholic cirrhosis of liver K704 Alcoholic hepatic failure K709 Alcoholic liver disease, unspecified K852 Alcohol-induced acute pancreatitis K860 Alcohol-induced chronic pancreatitis Q99304, Q99305 Maternal care for suspected damage to fetus from alcohol / Fetal Alcohol Syndrome R780 Finding of alcohol in blood T510 Toxic effect of alcohol T519 Toxic effect of alcohol, unspecified X45 Accidental poisoning by and exposure to alcohol X65 Intentional self-poisoning by and exposure to alcohol Y15 Poisoning by and exposure to alcohol, undetermined intent

Data Sources
Data were obtained using linked health administrative data held by ICES, an independent, nonprofit research institute whose legal status under Ontario's health information privacy law allows it to collect and analyze health care and demographic data, without consent, for health system evaluation and improvement. Data on demographic characteristics, ED visits and death were obtained through the following linked, de-identified health administrative databases at ICES: 1)

Analyses
We present descriptive statistics including rates and proportions for the probability of all-cause mortality in the 365 days following an index event for four groups: the general population of Ontario (excluding those who had one or more ED visit due to alcohol during the study period), and individuals with a total of 1 (i.e., zero additional ED visits due to alcohol), 2 and 3 or more ED visits due to alcohol respectively in the year following the initial ED visit due to alcohol.
Each individual in our study could only contribute a maximum of one year to follow up.
Individuals were followed until one of the followed occurred a) a year had passed since their first point of eligibility, b) they died or c) they lost coverage for the Ontario Health Insurance Program (the province of Ontario's universal health care coverage). For individuals with ED visits due to alcohol follow up began after their first ED visit due to alcohol in the study period (individuals with more than 1 ED visits due to alcohol in a year were followed for up to 365 days following the final ED visit in that year). For individuals in the general population of Ontario without an ED visit due to alcohol during the entire study period follow up began at the first point of study eligibility.
We used Poisson models offset by the log transformed person time at risk to calculate Incidence Rate Ratios (IRR) with 95% confidence intervals for the risk of death in the three groups of individuals with ED visits due to alcohol (1, 2, 3+ visits in a year) relative to the general population. We ran one overall model and then six separate Poisson models stratified by age and sex (men aged 15-29, 30-44, 45-59 years and women aged 15-29, 30-44, 45-59 years).