Indicator Metadata

NameHospitalizations Entirely Caused by Alcohol
Short/Other Names

100% Alcohol-Attributable Hospitalizations (AAHs)

Description

Age-standardized rate of hospitalizations with conditions that are wholly (100%) attributable to alcohol per 100,000 population age 10 and older.

For further details, please see the General Methodology Notes.

InterpretationLower rates are desirable.
HSP Framework Dimension

Health System Outcomes: Improve health status of Canadians

Areas of Need

Staying Healthy

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Region

Indicator Results

Accessing Indicator Results on Your Health System: In Depth

Identifying Information
NameHospitalizations Entirely Caused by Alcohol
Short/Other Names

100% Alcohol-Attributable Hospitalizations (AAHs)

Indicator Description and Calculation
Description

Age-standardized rate of hospitalizations with conditions that are wholly (100%) attributable to alcohol per 100,000 population age 10 and older.

For further details, please see the General Methodology Notes.

Calculation: Description

(Total number of hospitalizations with wholly alcohol-attributable conditions among patients age 10 and older ÷ Total mid-year population age 10 and older) × 100,000 (age-adjusted)

Unit of analysis: Single discharge

Calculation: Geographic Assignment

Place of residence

Calculation: Type of Measurement

Rate - Rate per 100,000

Calculation: Adjustment Applied

Age-adjusted

Calculation: Method of Adjustment

Direct Standardization
Standard Population:
Canada 2011

Denominator

Description:
Total mid-year population age 10 and older

Numerator

Description:
Total number of hospitalizations with wholly alcohol-attributable conditions among patients age 10 and older
Inclusions:
– Sex recorded as male or female
– Discharge from a general or psychiatric hospital, or a day surgery clinic
– The following codes were used to identify conditions wholly attributable to alcohol:
 

— Outside Quebec
a) Inpatient records: ICD-10-CA codes for conditions 100% attributable to alcohol (or 100% alcohol-attributable fraction [AAF] codes) (see Appendix 1, ICD-10-CA codes) coded as diagnosis type (M), (1), (W), (X), (Y) or (9) in the Discharge Abstract Database (DAD); or

b) Day surgery records: 100% AAF codes (see Appendix 1, ICD-10-CA codes) coded as Main Problem (MP) or Other Problem (OP) in the National Ambulatory Care Reporting System (NACRS) or as type (M), (1) or (9) in the DAD; or

c) Records from the Ontario Mental Health Reporting System (OMHRS):

– DSM-IV-TR 100% AAF codes (see Appendix 1, DSM-IV codes) coded as a principal diagnosis or secondary diagnosis for inpatient records; or
– (For patients with missing DSM-IV-TR codes) a category diagnosis of substance abuse coded as a principal diagnosis or secondary diagnosis and emergency department visit with 100% AAF codes (see Appendix 1, ICD-10-CA codes) in NACRS within 7 days prior to admission to OMHRS bed
 
— In Quebec
a) Inpatient and day surgery records:
– 100% AAF codes (see Appendix 1, ICD-10-CA codes) coded as type (M), (1), (W), (X), (Y) or (9) in the Hospital Morbidity Database (HMDB); or
– 100% AAF codes (see Appendix 1, ICD-10-CA codes) coded as type (C) and
b) ICD-10-CA codes for conditions partially attributable to alcohol (partial AAF codes) (see Appendix 2) coded as diagnosis type (M) or (9)
 

For detailed descriptions of the 100% AAF and partial AAF codes, as well as the OHMRS DSM-IV codes, see the 100% Alcohol-Attributable Hospitalizations — Appendices to Indicator Library.

Background, Interpretation and Benchmarks
Rationale

Harmful use of alcohol has serious effects not only on selected individuals, but also on a community as a whole. It also puts unnecessary strain on limited health care resources. Harmful use of alcohol is associated with a wide range of health conditions and is one of the leading factors in death, disease and disability. Harmful alcohol consumption can cause harm to other individuals in a manner that is intentional (assault) or unintentional (traffic accidents and fatalities).

Comparable prevalence data on harmful alcohol use is not available; however, hospital discharges can be used as a proxy for alcohol harm in the community and of the burden it imposes on health systems. An indicator that measures alcohol-attributable hospitalizations (AAHs) can help

– Bring awareness to the seriousness of harm associated with alcohol use
– Estimate the magnitude of hospital use due to alcohol harm to inform service needs for access to appropriate primary health care services, community addictions or rehab services, community mental health or social services, education and prevention
– Identify local areas of concern and flag potential issues with access to appropriate services (such as primary care and/or community and social services)
– Signal future health service needs and proper resource allocation for both management and prevention of harmful alcohol use
– Drive action to reduce and prevent the burden of alcohol harm by informing alcohol policy and priority areas of need
– Monitor the effectiveness of alcohol policies in place

Interpretation

Lower rates are desirable.

HSP Framework Dimension

Health System Outcomes: Improve health status of Canadians

Areas of Need

Staying Healthy

Targets/Benchmarks

Not applicable

References

1. World Health Organization. Global Status Report on Alcohol and Health 2014. 2014.

2. Rehm J, Baliunas D, Borges GL, et al. The relation between different dimensions of alcohol consumption and burden of disease: An overview. Addiction. 2010.

3. Rehm J, Shield KD. Alcohol Consumption, Alcohol Dependence and Attributable Burden of Disease in Europe: Potential Gains From Effective Interventions for Alcohol Dependence. 2012.

4. Patra J, Taylor B, Rehm J, et al. Substance-attributable morbidity and mortality changes to Canada’s epidemiological profile: Measurable differences over a ten-year period. Canadian Journal of Public Health. 2007.

5. Holmes J, Angus C, Buykx P, et al. Mortality and Morbidity Risks From Alcohol Consumption in the UK: Analyses Using the Sheffield Alcohol Policy Model (v.2.7) to Inform the UK Chief Medical Officers’ Review of the UK Lower Risk Drinking Guidelines. 2016.

6. Statistics Canada. Heavy drinking, 2014. Accessed August 12, 2016.

7. Rehm J, Giesbrecht N, Patra J, Roerecke M. Estimating chronic disease deaths and hospitalizations due to alcohol use in Canada in 2002: Implications for policy and prevention strategies. Preventing Chronic Disease. 2006.

8. Canadian Public Health Association. Too High a Cost: A Public Health Approach to Alcohol Policy in Canada. 2011.

9. Young MM, Jesseman RJ. The Impact of Substance Use Disorders on Hospital Use. 2014.

10. Keurhorst M, van de Glind I, Bitarello do Amaral-Sabadini M, et al. Implementation strategies to enhance management of heavy alcohol consumption in primary health care: A meta-analysis. Addiction. 2015.

11. World Health Organization.Sixtieth World Health Assembly: Provisional Agenda Item 12.7 — Evidence-Based Strategies and Interventions to Reduce Alcohol-Related Harm. 2007.

12. World Health Organization.Global Strategy to Reduce the Harmful Use of Alcohol. 2010.

13. National Alcohol Strategy Working Group. Reducing Alcohol-Related Harm in Canada: Toward a Culture of Moderation. 2007.

14. Association of Public Health Epidemiologists in Ontario. Alcohol attributable hospitalizations for selected chronic disease and injuries. Accessed October 4, 2016.

15. Centre for Addictions Research of BC. Hospitalizations and deaths in BC.
Accessed August 12, 2016.

16. Public Health England. Local alcohol profiles for England. Accessed August 12, 2016.

17. National Drug Research Institute. Bulletin 1: Alcohol-Caused Deaths and Hospitalisations in Australia, 1990–1997. 1999.

18. County Health Rankings and Roadmaps. Alcohol-related hospitalizations. Accessed August 10, 2016.

Availability of Data Sources and Results
Data Sources

DAD, HMDB, NACRS, OMHRS

Available Data Years

Type of Year:
Fiscal
First Available Year:
2015
Last Available Year:
2015

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Region

Result Updates
Update Frequency

Every year

Indicator Results

Web Tool:
Your Health System: In Depth
URL:
Accessing Indicator Results on Your Health System: In Depth

Updates

Not applicable

Quality Statement
Caveats and Limitations

–The indicator measures hospitalizations due to conditions wholly attributable to alcohol. Conditions partially attributable to alcohol (e.g., cancers, strokes, respiratory diseases) are not directly captured. This should be taken into consideration while interpreting the indicator results. It is estimated that out of all hospitalizations attributable to alcohol, 30% are due to wholly attributable conditions and 70% are due to partially attributable conditions.

–This indicator depends on the documentation of alcohol as the cause of a disease condition (100% attributable) for which care is delivered. Therefore, conditions potentially related to alcohol but not diagnosed and documented as such (e.g., liver disease not linked to alcohol) might not be captured.

–The stigma associated with alcohol influences the documentation of conditions associated with alcohol use. The increasing caution of clinical staff and the sensitivity of patients around documentation of alcohol use may affect the proportion of certain conditions with a documented link to alcohol.

–Accidents and injuries to self or others are major consequences of harmful use of alcohol; however, this indicator’s focus is on mental and medical conditions attributable to alcohol. Injuries to others are not captured, but patients admitted because of the conditions attributable to alcohol may have physical injuries as well.

–Since treatment for alcohol-attributable conditions may happen at different levels of the health care system, including clinics, emergency departments, and general and psychiatric hospitals, variations in indicator results are influenced by service delivery and capacity, access to care, and type of delivery and provider.

Trending Issues

Not applicable

Comments

Indicator results are also available in

–Your Health System: In Brief