Health service use among Manitobans with alcohol use disorder: a population-based matched cohort study

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

doi:10.9778/cmajo.20200124

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Figure 1:
Crude annual rates of hospital days for women (top) and men (bottom) with and without alcohol use disorder (cases and controls, respectively), before and after the index date, per 100 person-years (PYs), where the index date was the date of first diagnosis of alcohol use disorder. Note: CI = confidence interval.
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Figure 2:
Ten most common causes of admission to hospital, according to chapters of the Canadian version of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10-CA) for women (top) and men (bottom) with and without alcohol use disorder (cases and controls, respectively) in the year before, the year after and 5 years after the index date. Hospital admissions included obstetric admissions, and these data cover admissions of Manitobans to hospitals in any Canadian province.
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Figure 3:
Ten most commonly dispensed prescription medications by Anatomic Therapeutic Chemical (ATC) classification category for women (top) and men (bottom) with and without alcohol use disorder (cases and controls, respectively) in the year before, the year after and 5 years after index date. Nonprescription medications and medications from hospital-based pharmacies were excluded.

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Table 1:

Characteristics of the study population

Characteristic	Sex; study group;^* no. (%) of participants^†

	Women			Men

	Manitoba n = 560 102	Cases n = 19 017	Controls n = 94 566	Manitoba n = 544 672	Cases n = 34 393	Controls n = 170 291
Age at diagnosis, yr, mean (95% CI)	44.9 (44.8–44.9)	38.3 (38.1–38.6)	38.3 (38.2–38.4)	43.1 (43.0–43.1)	42.2 (42.0–42.4)	42.2 (42.1–42.3)

Age group, yr	NA			NA

12–17		2184 (11.5)	11 030 (11.7)		1915 (5.6)	11 097 (6.5)

18–24		3687 (19.4)	18 232 (19.3)		5791 (16.8)	27 537 (16.2)

25–29		2086 (11.0)	10 232 (10.8)		3276 (9.5)	15 517 (9.1)

30–34		1876 (9.9)	9346 (9.9)		3202 (9.3)	15 465 (9.1)

35–39		1549 (8.1)	7704 (8.2)		2970 (8.6)	14 668 (8.6)

40–44		1475 (7.8)	7356 (7.8)		2792 (8.1)	14 034 (8.2)

45–49		1231 (6.5)	6133 (6.5)		2678 (7.8)	13 226 (7.8)

50–54		972 (5.1)	4870 (5.2)		2370 (6.9)	12 002 (7.0)

55–59		775 (4.1)	3852 (4.1)		2183 (6.3)	10 962 (6.4)

60–64		684 (3.6)	3431 (3.6)		1869 (5.4)	9316 (5.5)

65–69		654 (3.4)	3232 (3.4)		1792 (5.2)	8965 (5.3)

70–74		560 (2.9)	2789 (3.0)		1458 (4.2)	7182 (4.2)

75–79		548 (2.9)	2735 (2.9)		1091 (3.2)	5412 (3.2)

80–84		383 (2.0)	1889 (2.0)		631 (1.8)	3103 (1.8)

85–89		247 (1.3)	1224 (1.3)		294 (0.9)	1429 (0.8)

≥ 90		106 (0.6)	511 (0.5)		81 (0.2)	376 (0.2)

Urban residence	353 506 (63.1)	10 527 (55.4)	52 477 (55.5)	336 087 (61.7)	18 940 (55.1)	94 347 (55.4)

Income quintile

Urban 1 (lowest)	68 287 (12.2)	4326 (22.7)	21 607 (22.8)	64 495 (11.8)	6727 (19.6)	33 586 (19.7)

Urban 2	70 370 (12.6)	2131 (11.2)	10 634 (11.2)	66 222 (12.2)	4109 (11.9)	20 519 (12.0)

Urban 3	69 913 (12.5)	1661 (8.7)	8290 (8.8)	66 089 (12.1)	3230 (9.4)	16 113 (9.5)

Urban 4	69 155 (12.3)	1167 (6.1)	5813 (6.1)	67 598 (12.4)	2541 (7.4)	12 654 (7.4)

Urban 5 (highest)	70 751 (12.6)	955 (5.0)	4774 (5.0)	68 231 (12.5)	1958 (5.7)	9777 (5.7)

Rural 1 (lowest)	38 419 (6.9)	3096 (16.3)	15 343 (16.2)	38 845 (7.1)	4976 (14.5)	24 248 (14.2)

Rural 2	41 532 (7.4)	1879 (9.9)	9337 (9.9)	41 626 (7.6)	3244 (9.4)	15 925 (9.4)

Rural 3	42 333 (7.6)	1193 (6.3)	5912 (6.3)	42 326 (7.8)	2543 (7.4)	12 641 (7.4)

Rural 4	41 124 (7.3)	1216 (6.4)	6063 (6.4)	41 872 (7.7)	2383 (6.9)	11 794 (6.9)

Rural 5 (highest)	41 876 (7.5)	1053 (5.5)	5251 (5.6)	42 813 (7.9)	2230 (6.5)	11 087 (6.5)

Unknown	6342 (1.1)	340 (1.8)	1542 (1.6)	4555 (0.8)	452 (1.3)	1947 (1.1)

RUB

0 (non-users)	89 515 (16.0)	6209 (32.6)	31 197 (33.0)	156 053 (28.7)	15 728 (45.7)	77 863 (45.7)

1 (lowest morbidity)	54 857 (9.8)	687 (3.6)	6710 (7.1)	55 758 (10.2)	1322 (3.8)	10 619 (6.2)

2	139 029 (24.8)	2707 (14.2)	19 234 (20.3)	133 932 (24.6)	4738 (13.8)	29 650 (17.4)

3	248 581 (44.4)	7757 (40.8)	33 718 (35.7)	175 721 (32.3)	10 361 (30.1)	45 652 (26.8)

4	23 898 (4.3)	1416 (7.4)	3191 (3.4)	19 391 (3.6)	1872 (5.4)	5467 (3.2)

5 (highest morbidity)	4222 (0.8)	241 (1.3)	516 (0.5)	3817 (0.7)	372 (1.1)	1040 (0.6)

Mental disorder

Mood or anxiety disorder	155 809 (27.8)	9809 (51.6)	19 428 (20.5)	85 360 (15.7)	10 724 (31.2)	18 608 (10.9)

Personality disorder	18 009 (3.2)	1226 (6.4)	723 (0.8)	13 998 (2.6)	1330 (3.9)	1035 (0.6)

Psychosis	8633 (1.5)	1269 (6.7)	1541 (1.6)	8394 (1.5)	2218 (6.4)	2678 (1.6)

Note: AUD = alcohol use disorder, CI = confidence interval, NA = not available, RUB = Johns Hopkins Resource Utilization Band.
↵* Cases = people with diagnosis of AUD who were included in the study; controls = people without diagnosis of AUD who were included in the study.
↵† Except where indicated otherwise.

Table 2:

Adjusted rate ratios^* for health service use during the year of first diagnosis of alcohol use disorder

Variable	Sex; adjusted rate ratio (95% CI)
Variable	Women	Men
Hospital admissions	4.0 (3.9–4.2)	4.5 (4.4–4.7)
Outpatient physician visits	1.7 (1.7–1.8)	2.0 (1.9–2.0)
No. of medications prescribed	1.8 (1.7–1.8)	1.9 (1.8–1.9)
Emergency department visits^†	3.8 (3.4–4.3)	3.6 (3.2–3.9)
Days in hospital	7.9 (7.1–8.8)	9.2 (8.4–10.1)

Note: CI = confidence interval.
↵* Adjusted for mental health disorders, age at index diagnosis, region of residence and income level.
↵† Visits included only those made by Winnipeg residents to any of the 6 Winnipeg emergency departments (women, n = 7548; men, n = 12 833).