Use of pharmacotherapy for alcohol use disorder in Manitoba, Canada: A whole-population cohort study

Konrad, Geoffrey; Leong, Christine; Bolton, James M.; Prior, Heather J.; Paillé, Michael T.; Nepon, Josh; Singal, Deepa; Ekuma, Okechukwu; Enns, Jennifer; Nickel, Nathan

doi:10.1371/journal.pone.0257025

Cited by 9 publications

(18 citation statements)

References 34 publications

(47 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…All this research, including corroborating international reports, has generated substantial interest in monitoring national trends in alcohol-related hospitalizations and developing strategies to reduce the risk of postdischarge harm and recurrent health service use. However, much of this work amalgamates everyone who experiences an alcohol-related hospitalization into a single cohort of individuals with a presumed AUD . In turn, there has been relatively little focus on the clinical diversity that exists within this population or if certain subgroups merit prioritization in efforts to reduce the risk of adverse outcomes.…”

Section: Discussionmentioning

confidence: 99%

Outcomes in Clinical Subgroups of Patients With Alcohol-Related Hospitalizations

Friesen,

Mataruga,

Nickel

et al. 2024

JAMA Netw Open

Self Cite

View full text Add to dashboard Cite

ImportanceAlcohol-related hospitalizations are common and associated with significant cost to the health care system. We have a limited understanding of the characteristics of individuals who experience alcohol-related hospitalizations, which limits our capacity to prioritize those at the highest risk of postdischarge harm.ObjectiveTo identify and characterize the clinical subgroups of individuals who are hospitalized for alcohol-related harms.Design, Setting, and ParticipantsThis cohort study used latent class analysis (LCA) to identify clinical subgroups of individuals experiencing alcohol-related hospitalizations in 2 provinces in Canada. All individuals between ages 10 and 105 years who were hospitalized for an alcohol-related harm between January 2017 and December 2018 (ie, the index hospitalization) were eligible. Data were analyzed between June 2023 and August 2023.ExposuresThe exposure of interest was the clinical subgroup that an individual belonged to. These subgroups were identified using an LCA based on (1) the characteristics of the index hospitalization and (2) the history of alcohol-related health service use.Main Outcomes and MeasuresIn-hospital mortality, alcohol-related hospital readmission, and all-cause mortality in the year following discharge from the index hospitalization. The association between subgroup membership and the risk of in-hospital and postdischarge outcomes was evaluated using multivariable regression.ResultsA total of 34 043 individuals were included in analysis, 4753 from Manitoba (median [IQR] age, 49 [40-58] years; 1786 female [37.6%]) and 29 290 from Ontario (median [IQR] age, 57 [45-67] years; 8527 female [29.1%]). Seven subgroups were identified following a gradient from low-frequency service use for acute intoxication to high-frequency service use for severe alcohol use disorder and liver disease. In Ontario, there were 4431 individuals in the liver disease subgroup representing 15.5% of the cohort who were at the highest risk of 1-year mortality (1382 [31.2%]) relative to the acute intoxication subgroup (42 [4.0%]) (adjusted hazard ratio [aHR], 3.83; 95% CI, 2.80-5.24). There was also a small subgroup (10.6%) of individuals with high-frequency alcohol-related health service use who had a much higher hazard of readmission following the index hospitalization (1-year readmission: 703 of 1526 [46.1%] vs 104 of 1058 [9.8%] in the acute intoxication subgroup; aHR, 5.09; 95% CI, 4.11-6.31).Conclusions and RelevanceIn this population-based cohort study of individuals experiencing alcohol-related hospitalizations, we identified several small, clinically distinct subgroups that were at a disproportionately high risk of readmission and mortality. These groups could merit prioritization in strategies aimed at reducing the risk of adverse outcomes following alcohol-related hospitalizations.

show abstract

Section: Discussionmentioning

confidence: 99%

Outcomes in Clinical Subgroups of Patients With Alcohol-Related Hospitalizations

Friesen,

Mataruga,

Nickel

et al. 2024

JAMA Netw Open

Self Cite

View full text Add to dashboard Cite

show abstract

“…Although our analyses are exploratory and did not identify causal factors underlying frequent ED visits, we hypothesize that recurrent ED visits by our patient cohort may suggest gaps in access to evidence-based substance use disorder management and mental health care in EDs and communities [ 47 ], particularly for the “extreme” subgroup. For instance, patients may present to EDs when their substance use-related needs are not met elsewhere, such as when primary care physicians are uncomfortable with substance use management and/or unable to liaise with addiction specialists.…”

Section: Discussionmentioning

confidence: 99%

Characterizing people with frequent emergency department visits and substance use: a retrospective cohort study of linked administrative data in Ontario, Alberta, and B.C., Canada

et al. 2022

View full text Add to dashboard Cite

Background Substance use is common among people who visit emergency departments (EDs) frequently. We aimed to characterize subgroups within this cohort to better understand care needs/gaps, and generalizability of characteristics in three Canadian provinces. Methods This was a retrospective cohort study (April 1st, 2013 to March 31st, 2016) of ED patients in Ontario, Alberta, and British Columbia (B.C.) We included patients ≥ 18 years with substance use-related healthcare contact during the study period and frequent ED visits, defined as those in the top 10% of ED utilization when all patients were ordered by annual ED visit number. We used linked administrative databases including ED visits and hospitalizations (all provinces); mental heath-related hospitalizations (Ontario and Alberta); and prescriptions, physician services, and mortality (B.C.). We compared to cohorts of people with (1) frequent ED visits and no substance use, and (2) non-frequent ED visits and substance use. We employed cluster analysis to identify subgroups with distinct visit patterns and clinical characteristics during index year, April 1st, 2014 to March 31st, 2015. Results In 2014/15, we identified 19,604, 7,706, and 9,404 people with frequent ED visits and substance use in Ontario, Alberta, and B.C (median 37–43 years; 60.9–63.0% male), whose ED visits and hospitalizations were higher than comparison groups. In all provinces, cluster analyses identified subgroups with “extreme” and “moderate” frequent visits (median 13–19 versus 4–6 visits/year). “Extreme” versus “moderate” subgroups had more hospitalizations, mental health-related ED visits, general practitioner visits but less continuity with one provider, more commonly left against medical advice, and had higher 365-day mortality in B.C. (9.3% versus 6.6%; versus 10.4% among people with frequent ED visits and no substance use, and 4.3% among people with non-frequent ED visits and substance use). The most common ED diagnosis was acute alcohol intoxication in all subgroups. Conclusions Subgroups of people with “extreme” (13–19 visits/year) and “moderate” (4–6 visits/year) frequent ED visits and substance use had similar utilization patterns and characteristics in Ontario, Alberta, and B.C., and the “extreme” subgroup had high mortality. Our findings suggest a need for improved evidence-based substance use disorder management, and strengthened continuity with primary and mental healthcare.

show abstract

“…Urban and rural areas receive vastly different levels of treatment for alcohol use disorders, particularly when it comes to evidence-based care. A Canadian study found that family doctors and psychiatrists in urban areas were the primary prescribers of pharmacological treatments for alcohol use disorder, such as naltrexone, acamprosate, and disulfiram [34 ▪ ]. If a person resided in an urban area as opposed to a rural one, they were more likely to fill a prescription for medication for alcohol use disorder [34 ▪ ].…”

Section: Treatment Hospitalizations and Mortalitymentioning

confidence: 99%

“…A Canadian study found that family doctors and psychiatrists in urban areas were the primary prescribers of pharmacological treatments for alcohol use disorder, such as naltrexone, acamprosate, and disulfiram [34 ▪ ]. If a person resided in an urban area as opposed to a rural one, they were more likely to fill a prescription for medication for alcohol use disorder [34 ▪ ]. However, the treatment rates are very low.…”

Section: Treatment Hospitalizations and Mortalitymentioning

confidence: 99%

Urbanicity and alcohol use epidemiology in the 21st century

Castaldelli‐Maia

2023

Current Opinion in Psychiatry

View full text Add to dashboard Cite

Purpose of reviewThis review aimed to gather recent studies that could identify the specificities in the relationship between urbanization and alcohol use epidemiology in the current century.Recent findingsAlthough we find lower rates of alcohol use among adolescents in urban environments than in rural ones, this difference tends to diminish until it disappears by the time they reach adulthood. In addition to excessive marketing and increased accessibility, several urban environment characteristics have been related to alcohol use. First, problematic alcohol use is linked to stress and mental health problems like depression and anxiety, which are common in metropolitan areas. Second, alcohol use behaviors are influenced by homelessness, loneliness, and deprivation in megacities, where female and male individuals have presented more similar alcohol use behaviors (i.e. gender convergence). Third, treatment levels for alcohol use disorders are very low.SummaryThere is a new epidemiological wave of alcohol consumption in large urban centers, largely influenced by advertisement and marketing. Social and psychological risk factors and subpopulations of interest were identified for preventive interventions in large urban centers (i.e. advertisement regulation). In addition, increasing the availability of treatment, including specific medications for alcohol use disorder, should be strongly encouraged.

show abstract

Use of pharmacotherapy for alcohol use disorder in Manitoba, Canada: A whole-population cohort study

Cited by 9 publications

References 34 publications

Outcomes in Clinical Subgroups of Patients With Alcohol-Related Hospitalizations

Outcomes in Clinical Subgroups of Patients With Alcohol-Related Hospitalizations

Characterizing people with frequent emergency department visits and substance use: a retrospective cohort study of linked administrative data in Ontario, Alberta, and B.C., Canada

Urbanicity and alcohol use epidemiology in the 21st century

Contact Info

Product

Resources

About