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Health and Social Outcomes Associated with High-Risk Alcohol Use

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Manitoba Centre for Health Policy Health and Social Outcomes Associated with High-Risk Alcohol Use Summer 2018 Nathan C Nickel, MPH, PhD Jeff Valdivia, MNRM, CAPM Deepa Singal, PhD James Bolton, MD Christine Leong, PharmD Susan Burchill, BMus Leonard MacWilliam, MSc, MNRM Geoffrey Konrad, MD Randy Walld, BSc, BComm (Hons) Okechukwu Ekuma, MSc Greg Finlayson, PhD Leanne Rajotte, BComm (Hons) Heather Prior, MSc Josh Nepon, MD Michael Paille, BHSc This report is produced and published by the Manitoba Centre for Health Policy (MCHP). It is also available in PDF format on our website at: http://mchp-appserv.cpe.umanitoba.ca/deliverablesList.html Information concerning this report or any other report produced by MCHP can be obtained by contacting: Manitoba Centre for Health Policy Rady Faculty of Health Sciences Max Rady College of Medicine, University of Manitoba 4th Floor, Room 408 727 McDermot Avenue Winnipeg, Manitoba, Canada R3E 3P5 Email: [email protected] Phone: (204) 789-3819 Fax: (204) 789-3910 How to cite this report: Nathan C Nickel, James Bolton, Leonard MacWilliam, Okechukwu Ekuma, Heather Prior, Jeff Valdivia, Christine Leong, Geoffrey Konrad, Greg Finlayson, Josh Nepon, Deepa Singal, Susan Burchill, Randy Walld, Leanne Rajotte, Michael Paille. Health and Social Outcomes Associated with High-Risk Alcohol Use. Winnipeg, MB. Manitoba Centre for Health Policy, Summer 2018. Legal Deposit: Manitoba Legislative Library National Library of Canada ISBN 978-1-896489-90-2 ©Manitoba Health This report may be reproduced, in whole or in part, provided the source is cited. 1st printing (Summer 2018) This report was prepared at the request of Manitoba Health, Seniors and Active Living (MHSAL), a department within the Government of Manitoba, as part of the contract between the University of Manitoba and MHSAL. It was supported through funding provided by MHSAL to the University of Manitoba (HIPC 2014/2015 - 30). The results and conclusions are those of the authors and no official endorsement by MHSAL was intended or should be inferred. Data used in this study are from the Manitoba Population Research Data Repository housed at the Manitoba Centre for Health Policy, University of Manitoba and were derived from data provided by MHSAL, the Winnipeg Regional Health Authority, CancerCare Manitoba, Manitoba Families, Healthy Child Manitoba Office, Manitoba Justice, the Vital Statistics Agency and Statistics Canada. Strict policies and procedures were followed in producing this report to protect the privacy and security of the Repository data. Health and Social Outcomes Associated with Alcohol Use in Manitoba About the Manitoba Centre for Health Policy The Manitoba Centre for Health Policy (MCHP) is located to contribute to the health policy process. MCHP undertakes within the Department of Community Health Sciences, several major research projects, such as this one, every Max Rady College of Medicine, Rady Faculty of Health year under contract to Manitoba Health, Seniors and Active Sciences, University of Manitoba. The mission of MCHP is Living. In addition, our researchers secure external funding to provide accurate and timely information to healthcare by competing for research grants. We are widely published decision–makers, analysts and providers, so they can offer and internationally recognized. Further, our researchers services which are effective and efficient in maintaining collaborate with a number of highly respected scientists and improving the health of Manitobans. Our researchers from Canada, the United States, Europe, and Australia. rely upon the unique Manitoba Population Research Data We thank the Health Research Ethics Board, University Repository (Repository) to describe and explain patterns of Manitoba, Rady Faculty of Health Sciences, Max Rady of care and profiles of illness and to explore other factors College of Medicine, Health Research Ethics Board for their that influence health, including income, education, review of this project. MCHP complies with all legislative employment, and social status. This Repository is unique in acts and regulations governing the protection and use terms of its comprehensiveness, degree of integration, and of sensitive information. We implement strict policies orientation around an anonymized population registry. and procedures to protect the privacy and security of Members of MCHP consult extensively with government anonymized data used to produce this report and we officials, healthcare administrators, and clinicians to develop keep the provincial Health Information Privacy Committee a research agenda that is topical and relevant. This strength, informed of all work undertaken for Manitoba Health, along with its rigorous academic standards, enables MCHP Seniors and Active Living. www.mchp.ca i Health and Social Outcomes Associated with High-Risk Alcohol Use ii Manitoba Centre for Health Policy Rady Faculty of Health Sciences University of Manitoba Acknowledgments Acknowledgments The authors thank the individuals whose knowledge and contributions made it possible to produce this report. We apologize in advance to anyone we may have inadvertently omitted. We thank our Advisory Group for their input and expertise: • Jasmine Thomas (Liquor and Gaming Authority of Manitoba) • Stephanie Loewen (Manitoba Health, Seniors and Active Living) • Marcia Thomson (Manitoba Health, Seniors and Active Living) • Dr. Michael Routledge (Southern Health-Santé Sud) • Rusty Beardy (Northern Health Region) • Michele Jules (Manitoba Prosecution Service) • Dr. Tim Stockwell (University of Victoria) • Susan Maxwell (Addictions Foundation of Manitoba) • Susan Chipperfield (Winnipeg Regional Health Authority) • Linda Conover (Winnipeg Regional Health Authority) • Richard Lennon (Manitoba Liquor & Lotteries) • Bev Mehmel (Manitoba Liquor & Lotteries) • Dr. David Brown (Pathways Research Ltd) • Tina Leclair (Manitoba Health, Seniors and Active Living) • Ken Mackenzie (Winnipeg Regional Health Authority) We are grateful for the feedback provided by our external reviewers Drs. Elizabeth Evans (University of Massachusetts Amherst) and Sheryl Spithoff (University of Toronto). We thank our colleagues at the Manitoba Centre for Health Policy for their valuable contributions: Dr. Malcolm Doupe (senior reader), Dr. Jennifer Enns (editor), Chelsey McDougall, Ruth-Ann Soodeen, Selena Randall, and Cara Jonasson. We acknowledge the University of Manitoba Health Research Ethics Board for their review of the proposed research project. The Health Information Privacy Committee (HIPC) is kept informed of all MCHP deliverables. The HIPC number for this project is 2014/2015 - 30. We also acknowledge Manitoba Health, Seniors and Active Living, as well as the Winnipeg Regional Health Authority, CancerCare Manitoba, Manitoba Families, Healthy Child Manitoba Office, Manitoba Justice, the Vital Statistics Agency, and Statistics Canada for the use of their data. www.mchp.ca iii Health and Social Outcomes Associated with High-Risk Alcohol Use iv Manitoba Centre for Health Policy Rady Faculty of Health Sciences University of Manitoba Table of Contents Table of Contents List of Figures vii List of Tables xiii List of Acronyms xv Executive Summary xvii Chapter 1: Introduction 1 Synopsis 1 Background on Alcohol Use 1 Study Objectives 2 Organization of Report 3 Chapter 2: Methods 5 Data Used in this Report 5 Study Population and Time Period 6 Outcome Variables 9 Statistical Analyses 11 Strengths and Limitations 12 Chapter 3: Demographics 15 Introduction 15 Individuals with an Alcohol Use Disorder 15 Conclusions 23 Chapter 4: Provincial Trends in Outcomes Associated with Alcohol Use Disorders: Health Services and Health and Social Outcomes 25 Health Services 25 Health Outcomes 31 Social Outcomes 38 Conclusions 45 Chapter 5: Patterns in Health Service Use Associated with Alcohol Use Disorders 47 Inpatient Hospitalization 48 Days Spent in Hospital 52 Ambulatory Visits (Physician Visits) 54 Prescription Drugs 58 Emergency Department Visits 62 Conclusions 65 Chapter 6: Patterns in Health Outcomes Associated with Alcohol Use Disorders 67 Total Mortality 68 Premature Mortality 71 Ischemic Heart Disease 74 Diabetes 78 Alcohol-Related Cancers 80 Conclusions 83 Chapter 7: Patterns in Social Outcomes Associated with Alcohol Use Disorders 85 Involvement with the Justice System 86 Social Housing 96 Children Taken into Care 99 Income Assistance 100 Conclusions 104 www.mchp.ca v Health and Social Outcomes Associated with High-Risk Alcohol Use Chapter 8: Outcomes Associated with Exceeding Recommended Low-Risk Drinking Limits 105 Self-Reported Drinking and AUD Diagnoses 106 Hospitalizations for Motor Vehicle Collisions 107 Hospitalizations for Injury 108 Admissions to Intensive Care Unit 109 Emergency Department Visits 110 Driving While Intoxicated 111 Domestic/Family Violence 112 Any Charge in the Justice System Database 113 Social Housing 114 Income Assistance 115 Conclusions 115 Chapter 9: Pharmacological Interventions for Alcohol Use Disorders 117 Pharmacotherapies for Alcohol Use Disorders 118 Descriptives for Individuals with an Alcohol Use Disorder and with a Pharmacotherapy Dispensation 118 Trends in Prescriptions by Fiscal Year 122 Conclusions 125 Chapter 10: Concluding Remarks 127 Key Findings on the Relationship between Harmful Alcohol Consumption and Health and Social Outcomes 127 Recommendations 128 Concluding Remarks 129 References 131 Appendix 1: Technical Definitions 135 Alcohol Use Disorder – Cases 135 Alcohol Use Disorder – Matches
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