Mortality Risk Following Nonfatal Injuries With Alcohol Use Disorder Involvement: A One-Year Follow-Up of Emergency Department Patients Using Linked Administrative Data

Abstract

Objective. Patient presentations to the emergency department (ED) for alcohol-involved injury represent a growing public health burden, but their characteristics and sequelae remain understudied.This study examined mortality rates among ED patients presenting with alcohol-involved injuries, and assessed how mortality varied by injury intent and other characteristics.Method. This retrospective cohort study used statewide, longitudinally-linked ED patient record and mortality data from California. Participants comprised all residents presenting to a licensed ED in 2009-2012 with a nonfatal injury that involved comorbid diagnosis of alcohol use disorder (AUD; n=261,222; 59.3% male). Injury intent was defined using International Classification of Diseases, 9 th Revision external cause-of-injury codes. Cox regression was used to investigate factors associated with 12-month all-cause mortality rates. Age-, sex-, and race/ethnicity-adjusted standardized mortality ratios (SMRs) were calculated using statewide mortality data. Results. Most ED injury visits involving an AUD diagnosis were coded as unintentional (75.9%).Following the index ED visit, all-cause mortality among AUD-involved injury patients was 5,205 per 100,000 person-years, five times higher than the demographically matched population (SMR: 5.3; 95% CI: 5.2, 5.4). Adjusted Cox regression models indicated that patients whose index injury was unintentional, and whose AUD was for acute intoxication, had significantly higher mortality. Most deaths among unintentionally-injured patients were from natural causes, while external-cause deaths were relatively more common in the other patient groups.Conclusions. AUD-involved injury presentations to the ED are common and associated with high patient mortality burden, which varies by injury intent. Interventions are needed to reduce excess mortality in these patients.

All‐cause and cause‐specific mortality in individuals with an alcohol‐related emergency or hospital inpatient presentation: A retrospective data linkage cohort study

“…acute injury mortality [ 16 , 17 , 18 ]), or specific subpopulations of people presenting to health services with an alcohol‐related diagnosis (e.g. people with a non‐fatal injury with a comorbid alcohol use disorder diagnosis [ 19 ]). The exception is a data linkage study of a Danish population‐based cohort of all adults with a first‐time hospital contact for an alcohol‐related diagnosis in 1998–2002 followed for mortality until 2012 [ 20 ].…”