Hospitalizations Entirely Caused by Alcohol
Lower rates are desirable.
(Total number of hospitalizations with wholly alcohol-attributable conditions among patients age 10 and older ÷ Total mid-year population age 10 and older) × 100,000 (age-adjusted)
Unit of analysis: Single discharge
Total mid-year population age 10 and older
Total number of hospitalizations with wholly alcohol-attributable conditions among patients age 10 and older
Methodology
Name
Hospitalizations Entirely Caused by Alcohol
Short/Other Names
100% Alcohol-Attributable Hospitalizations (AAHs)
Description
Age-standardized rate of hospitalizations with conditions that are wholly (100%) attributable to alcohol per 100,000 population age 10 and older.
The indicator uses a blended average methodology to calculate the overall Canada rate and Quebec’s rate. For further details, please see the General Methodology Notes (PDF).
Rationale
Harmful use of alcohol has serious effects not only on selected individuals, but also on a community as a whole. It also puts unnecessary strain on limited health care resources. Harmful use of alcohol is associated with a wide range of health conditions and is one of the leading factors in death, disease and disability. Harmful alcohol consumption can cause harm to other individuals in a manner that is intentional (assault) or unintentional (traffic accidents and fatalities).
Comparable prevalence data on harmful alcohol use is not available; however, hospital discharges can be used as a proxy for alcohol harm in the community and of the burden it imposes on health systems. An indicator that measures alcohol-attributable hospitalizations (AAHs) can help
- Bring awareness to the seriousness of harm associated with alcohol use
- Estimate the magnitude of hospital use due to alcohol harm to inform service needs for access to appropriate primary health care services, community addictions or rehab services, community mental health or social services, education and prevention
- Identify local areas of concern and flag potential issues with access to appropriate services (such as primary care and/or community and social services)
- Signal future health service needs and proper resource allocation for both management and prevention of harmful alcohol use
- Drive action to reduce and prevent the burden of alcohol harm by informing alcohol policy and priority areas of need
- Monitor the effectiveness of alcohol policies in place.
Interpretation
Lower rates are desirable.
HSP Framework Dimension
Health system outcomes: Improve health status of Canadians
Areas of Need
Staying Healthy
Targets/Benchmarks
Not applicable
Available Data Years
to (fiscal years)
Geographic Coverage
- All provinces/territories
Reporting Level/Disaggregation
- National
- Province/Territory
- Region
Indicator Results
Update Frequency
Every year
Latest Results Update Date
Updates
Not applicable
Description
(Total number of hospitalizations with wholly alcohol-attributable conditions among patients age 10 and older ÷ Total mid-year population age 10 and older) × 100,000 (age-adjusted)
Unit of analysis: Single discharge
Type of Measurement
Rate - per 100,000 population
Denominator
Description:
Total mid-year population age 10 and older
Numerator
Description:
Total number of hospitalizations with wholly alcohol-attributable conditions among patients age 10 and older
Inclusions:
- Sex recorded as male or female
- Discharge from a general or psychiatric hospital, or a day surgery clinic.
The following codes were used to identify conditions wholly attributable to alcohol:
Outside Quebec
- Inpatient and day surgery records:
- ICD-10-CA codes for conditions 100% attributable to alcohol (or 100% alcohol-attributable fraction [AAF] codes) (see Appendix 1) coded as diagnosis type (M), (1), (2), (W), (X), (Y) or (9) in the Discharge Abstract Database (DAD), or as Main Problem (MP) or Other Problem (OP) in the National Ambulatory Care Reporting System (NACRS); or
- Records from the Ontario Mental Health Reporting System (OMHRS):
- DSM-IV-TR, DSM-5 (ICD-9-CM) and DSM-5 (ICD-10-CM) 100% AAF codes (see Appendix 1) coded as a principal diagnosis or secondary diagnosis for inpatient records; or
- A category diagnosis of substance-related and addictive disorder coded as a principal diagnosis or secondary diagnosis and emergency department visit with 100% AAF codes in NACRS within 7 days prior to admission to an OMHRS bed (for patients without a DSM-IV-TR, DSM-5 [ICD-9-CM] or DSM-5 \[ICD-10-CM\] 100% AAF code and without another substance coded on the abstract)
In Quebec
- Inpatient and day surgery records:
- 100% AAF codes coded as type (M), (1), (2), (W), (X), (Y) or (9) in the Hospital Morbidity Database (HMDB); or
- 100% AAF codes (see Appendix 1) coded as type (C) and ICD-10-CA codes for conditions partially attributable to alcohol (partial AAF codes) (Appendix 2) coded as diagnosis type (M) or (9)
For detailed descriptions of the 100% AAF and partial AAF codes, as well as the OHMRS DSM-IV and DSM-5 codes, see the Hospitalizations Entirely Caused by Alcohol: Appendices to Indicator Library (PDF).
Exclusions:
- Records with admission category of cadaveric donor or stillbirth (Admission Category Code = R or S).
- 2018–2019 data onward: Medical assistance in dying (MAID) (Discharge Disposition Code = 73)
Method of Adjustment
Direct standardization
Standard Population:
Canada 2011
Adjustment Applied
Age-adjusted
Geographic Assignment
Place of residence
Data Sources
- DAD
- HMDB
- NACRS
- OMHRS
Caveats and Limitations
- The indicator measures hospitalizations due to conditions wholly attributable to alcohol. Conditions partially attributable to alcohol (e.g., cancers, strokes, respiratory diseases) are not directly captured. This should be taken into consideration while interpreting the indicator results. It is estimated that out of all hospitalizations attributable to alcohol, 30% are due to wholly attributable conditions and 70% are due to partially attributable conditions.
- This indicator depends on the documentation of alcohol as the cause of a disease condition (100% attributable) for which care is delivered. Therefore, conditions potentially related to alcohol but not diagnosed and documented as such (e.g., liver disease not linked to alcohol) might not be captured.
- The stigma associated with alcohol influences the documentation of conditions associated with alcohol use. The increasing caution of clinical staff and the sensitivity of patients around documentation of alcohol use may affect the proportion of certain conditions with a documented link to alcohol.
- Accidents and injuries to self or others are major consequences of harmful use of alcohol; however, this indicator's focus is on mental and medical conditions attributable to alcohol. Injuries to others are not captured, but patients admitted because of the conditions attributable to alcohol may have physical injuries as well.
- Since treatment for alcohol-attributable conditions may happen at different levels of the health care system, including clinics, emergency departments, and general and psychiatric hospitals, variations in indicator results are influenced by service delivery and capacity, access to care, and type of delivery and provider.
Trending Issues
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5 [ICD-9-CM]) was implemented in the Ontario Mental Health Reporting System as of 2016–2017. Prior to 2016–2017, the fourth edition (DSM-IV-TR) was used. DSM-5 was further updated in 2019 to DSM-5 (ICD-10-CM). Because DSM-IV-TR, DSM-5 (ICD-9-CM) and DSM-5 (ICD-10-CM) codes are not fully comparable, there may be some shift in the distribution of cases. Therefore, trends over time should be interpreted with caution.
References
- World Health Organization. Global Status Report on Alcohol and Health 2014. 2014.
- Rehm J, Baliunas D, Borges GL, et al. The relation between different dimensions of alcohol consumption and burden of disease: An overview. Addiction. 2010.
- Rehm J, Shield KD. Alcohol Consumption, Alcohol Dependence and Attributable Burden of Disease in Europe: Potential Gains From Effective Interventions for Alcohol Dependence (PDF). 2012.
- Patra J, Taylor B, Rehm J, et al. Substance-attributable morbidity and mortality changes to Canada's epidemiological profile: Measurable differences over a ten-year period. Canadian Journal of Public Health. 2007.
- Holmes J, Angus C, Buykx P, et al. Mortality and Morbidity Risks From Alcohol Consumption in the UK: Analyses Using the Sheffield Alcohol Policy Model (v.2.7) to Inform the UK Chief Medical Officers' Review of the UK Lower Risk Drinking Guidelines (PDF). 2016.
- Statistics Canada. Heavy drinking, 2014. Accessed September 20, 2024.
- Rehm J, Giesbrecht N, Patra J, Roerecke M. Estimating chronic disease deaths and hospitalizations due to alcohol use in Canada in 2002: Implications for policy and prevention strategies. Preventing Chronic Disease. 2006.
- Canadian Public Health Association. Too High a Cost: A Public Health Approach to Alcohol Policy in Canada (PDF). 2011.
- Young MM, Jesseman RJ. The Impact of Substance Use Disorders on Hospital Use (PDF). 2014.
- Keurhorst M, van de Glind I, Bitarello do Amaral-Sabadini M, et al. Implementation strategies to enhance management of heavy alcohol consumption in primary health care: A meta-analysis. Addiction. 2015.
- World Health Organization. Sixtieth World Health Assembly: Provisional Agenda Item 12.7 — Evidence-Based Strategies and Interventions to Reduce Alcohol-Related Harm (PDF). 2007.
- World Health Organization. Global Strategy to Reduce the Harmful Use of Alcohol (PDF). 2010.
- National Alcohol Strategy Working Group. Reducing Alcohol-Related Harm in Canada: Toward a Culture of Moderation (PDF). 2007.
- Association of Public Health Epidemiologists in Ontario. Alcohol attributable hospitalizations for selected chronic disease and injuries. Accessed September 20, 2024.
- Centre for Addictions Research of BC. Hospitalizations and deaths in BC. Accessed September 20, 2024.
- Public Health England. Local alcohol profiles for England. Accessed September 20, 2024.
- National Drug Research Institute. Bulletin 1: Alcohol-Caused Deaths and Hospitalisations in Australia, 1990-1997. 1999.
- County Health Rankings and Roadmaps. Alcohol-related hospitalizations. Accessed September 20, 2024.
How to cite:
Canadian Institute for Health Information. Hospitalizations Entirely Caused by Alcohol. Accessed April 24, 2025.
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Comments
Indicator results are also available in
Both the Hospitalizations Entirely Caused by Alcohol and the Hospital Stays for Harm Caused by Substance Use indicators have a common approach to case identification.
For additional information, please see Hospital Stays for Harm Caused by Substance Use.