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US Emergency Department Visits for Alcohol-Related Diseases and Injuries Between 1992 and 2000
Alden J. McDonald III, BA;
Nan Wang, BS;
Carlos A. Camargo, Jr, MD, DrPH
Arch Intern Med. 2004;164:531-537.
Background Alcohol-related diseases and injuries pose a significant burden on hospital emergency departments (EDs). Recognized limitations of self-reported data suggest that previous single-year national studies may have underestimated the magnitude of this burden.
Methods Data were obtained from the National Hospital Ambulatory Medical Care Survey for 1992 through 2000. Thirty-seven alcohol-related diagnoses and their corresponding alcohol-attributable fractions (AAFs) were used to estimate the number of ED visits attributable to alcohol. Diagnoses with an AAF of 1 were analyzed by age, sex, and race. Disposition to inpatient settings and alcohol screening also were examined.
Results During these 9 years, there were an estimated 68.6 million (95% confidence interval [CI], 65.6 million to 71.7 million) ED visits attributable to alcohol, a rate of 28.7 (95% CI, 27.1-30.3) per 1000 US population. The number of alcohol-related visits increased 18% during this period. Visit rates for diagnoses with AAFs of 1 were highest for those who were aged 30 through 49 years, male, and black. From 1992 to 2000, these disparities remained stable for age group but significantly changed for sex (+22%) and race (-76%). Most patients with diagnoses with AAFs of 1 were not admitted to an inpatient unit, and the percentage of patients who underwent blood alcohol concentration testing was substantially lower than corresponding AAFs.
Conclusions Alcohol-related ED visits are approximately 3 times higher than previous estimates determined by physician documentation or patient disclosure of alcohol involvement. Rising trends, changing disparities, and suboptimal ED management of such visits are a call to action.
From the Department of Emergency Medicine, Massachusetts General Hospital (Mr McDonald, Ms Wang, and Dr Camargo), and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School (Dr Camargo), Boston, Mass. The authors have no relevant financial interest in this article.
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