Alcohol linked ER visits by women and youth on the rise in Ont., study suggests

Alcohol-related health problems are posing a growing burden on Ontario emergency rooms, including a disproportionate spike in visits by women and young people, a new study suggests.

Experts say the findings signal that the harms of alcohol use are not only on the rise, but becoming more widespread across the population.

The study, published in the Canadian Medical Association Journal last month, looked at patterns in alcohol-related ER visits in Ontario between 2003 and 2016.

Researchers with the University of Ottawa, Ottawa Hospital, the Bruyere Research Institute and ICES (formerly known as the Institute for Clinical Evaluative Sciences) examined several databases of provincial records containing medical and demographic information for more than 15 million Ontario residents aged 10 to 105.

Using diagnostic codes, they found conditions caused by alcohol use—including acute intoxication, alcohol dependence and withdrawal and alcoholic liver disease—were listed as a main or contributing factor in 765,346 ER visits.

The number of alcohol-related ER visits climbed by an annual average of seven% over the 14-year period, increasing at 4.4 times the rate of ER visits overall, the study suggests.

Daniel Myran, lead author of the study, said these findings only represent the “tip of the iceberg” of the damage caused by drinking, noting the numbers don't account for long-term health hazards, accidents and “second-hand'' harm to others, such as violence.

“The increases we've seen in alcohol harms are affecting everyone in society, and they're doing so in an equal way,” said Myran, a family physician and resident at Ottawa Hospital, in a phone interview.

In keeping with previous trends, the data showed that more than two-thirds of patients who went to the ER because of alcohol use were men. But Myran said women have “narrowed that gap.''

Over the study period, the rate of alcohol-related ER visits by women rose 86.5%, compared to 53.2% for men.

The rate of alcohol-related ER visits spiked by 175% among individuals aged 25 to 29, and the change was even more pronounced among young women in the cohort, who saw an increase of 240%, researchers said.

This gender shift was also apparent in ER visits related to underage drinking, with the rates for women below the age of 19 exceeding those of their male peers since 2007, according to the study.

Sheryl Spithoff, an addiction medicine physician at Toronto's Women's College Hospital, who authored a commentary on the study, said the results are consistent with broader trends across the country.

Data from the Canadian Institute for Health Information suggests the rate of women dying from causes directly linked to alcohol rose by 26% between 2001 and 2016-2017, compared to a five% increase among men.

For physiological reasons, Spithoff said women are more vulnerable to the effects of alcohol, so it's unsurprising to see that they're disproportionately suffering health consequences.

In recent years, Canadian women have been consuming more alcohol following a shift in gender norms that made drinking more acceptable, said Spithoff.

This message has been amplified with the so-called “pinking” of alcohol marketing, she added, saying there's anecdotal evidence to suggest that advertisements are increasingly geared towards women.

Spithoff noted that in Ontario, rates of alcohol consumption remained relatively steady between 2011 and 2016, according to Statistics Canada, but it appears that people's habits have become more harmful, fuelled in part by a culture of binge drinking, particularly among young people.

Research indicates that regulations limiting the availability of alcohol can reduce the harms of substance use, she said. But in Ontario, she warned, it appears policy-makers are moving in the “opposite direction.”

Premier Doug Ford promised during last year's election campaign to make beer and wine available in corner stores, grocery stores and big-box stores.

Along with promising to expand beer and wine sales, the Progressive Conservative government has loosened rules around alcohol consumption in the province in their spring budget.

Ontario will now allow bars, restaurants, and golf courses to start serving alcohol at 9 a.m., seven days a week, and is promising consultations on a further increase in hours of services in the future.

The government will also let municipalities establish rules about where booze can be consumed in public, such as in some parks. Regulations are also changing to allow tailgating parties near sports events across the province.

“While the government trusts Ontarians to make smart, mature and responsible choices when it comes to alcohol use, it maintains a strong commitment to social responsibility,” a spokeswoman for Ontario's Health Ministry said in a email, pointing to provincial efforts to promote the safe consumption of alcohol, such as $3.8-billion investment to support people struggling with addiction.

But Spithoff said the results of the Ontario study show that provincial lawmakers need to not only reverse their policy direction, but make more drastic interventions, or we'll be paying the price for today's decisions in increased health-care costs down the road.

“I think we need to ... realize that alcohol is a substance that is as at least as harmful as cocaine and tobacco and treat it within a public health model,” she said.

“We would expect that with these policy changes consumption (will increase), and particularly in youth and people who drink heavily, and those groups are at most risk for harms.”