The distribution of alcohol-attributable healthcare encounters across the population of alcohol users in Ontario, Canada

Abstract

Recent evidence suggests there may be no safe level of alcohol use as even low levels are associated with increased risk for harm. However, the magnitude of the population-level health burden from lower levels of alcohol use is poorly understood. The objective was to estimate the distribution of alcohol-attributable healthcare encounters (emergency department (ED) visits and hospitalizations) across the population of alcohol users aged 15+ in Ontario, Canada. Using the International Model of Alcohol Harms and Policies (InterMAHP) tool, wholly and partially alcohol-attributable healthcare encounters were estimated across alcohol users: (1) former (no past-year use); (2) low volume (≤67.3 g ethanol/week); (3) medium volume (>67.3-134.5 g ethanol/week for women and >67.3-201.8 g ethanol/week for men); and (4) high volume (>134.5 g ethanol/week for women and >201.8 g ethanol/week for men). The alcohol-attributable healthcare burden was distributed across the population of alcohol users. A small population of high volume users (23% of men, 13% of women) were estimated to have contributed to the greatest proportion of alcohol-attributable healthcare encounters, particularly among men (men: 65% of ED visits and 71% of hospitalizations, women: 49% of ED visits and 50% of hospitalizations). The 71% of women low and medium volumes users were estimated to have contributed to a substantial proportion of alcohol-attributable healthcare encounters (47% of ED visits and 34% of hospitalizations). Findings provide support for universal alcohol policies (i.e., delivered to the entire population) for reducing population-level alcohol-attributable harm in addition to targeted policies for high-risk users.

Keywords: Alcohol use; Canada; Geoffrey Rose; Prevention paradox; Substance use; Universal policies.

Fig. 1

(a and b) The proportion of total alcohol consumed and alcohol-attributable healthcare encounters (emergency department (ED) visits in 2019 and hospitalizations in 2018) in Ontario estimated across alcohol user groups (former, low, medium, and high volume) for (a) men (n = 6,025,343) and (b) women (n = 6,248,839). Former alcohol users had no past-year alcohol use; low volume alcohol users had an average of up to 67.3 g ethanol/week, medium volume users had >67.3–134.5 g ethanol/week for women and >67.3–201.8 g ethanol/week for men, high volume users had >134.5 and >201.8 g ethanol/week for women and men, respectively.