Visits of adolescents for acute alcohol intoxication to emergency departments in Northern Italy: natives and non-natives

Background: In Italy, although the number of foreign-born residents has grown exponentially, there are still few studies oriented to the alcohol misuse concerning the population of minors. Our objective was to describe characteristics of minors (natives and non-natives) admitted to the Emergency Departments (ED) following Alcohol Acute Intoxication (AAI) in Northern Italy. Methods: We retrospectively evaluated all the records of patients aged 12–17 years admitted from 2009 to 2017 to 11 EDs. Results: Out of 97,445 minors, we identified 554 AAI: 39.2% female, 22.7% non-natives, 21% reported illegal substance use. We highlight a quote of 5.7 AAI admissions every thousand ED admissions, rising over time, higher among males (6.2) and non-natives (8.4). The standardized rates per thousand residents were 1.29, higher among males and non-natives. The non-natives are distinguished by a higher percentage of male, of clients of homes for minors/protected center, of patients with psychiatric drugs use. Minors born in Latin America had the highest proportion of AAI admissions and the highest standardized rates. Conclusions: AAI is increasing among Italian adolescents, particularly in the non-native population, and it is associated with illegal substance use. Differences emerge among the non-natives on the basis of their country of birth

Mortality risk among individuals treated for alcohol use disorders: results of a longitudinal study from 1978 to 2016 in Northern Italy

OBJECTIVE: The aim of this study was to examine the mortality trends and causes of death in Northern Italy in a cohort of a population of individuals treated for alcohol use disorder (AUD) over a 38-year follow-up period (1978-2016). MATERIALS AND METHODS: 6,198 patients attending eighteen centres for addiction treatment (CATs) for AUD were recruited. RESULTS: During the follow-up period, 19.5% of the whole cohort died. The crude mortality rates (CMRs) were elevated (21.34 x 1000 person-years [PY]), higher for men and increasing with age group. The CMRs were higher for all cancers, followed by digestive system diseases, diseases of the circulatory system, transport accidents, and suicide. The standardised mortality ratios (SMRs) were at least three times higher for women and for men, and they were more elevated in younger patients and have been falling since 2009. Multivariate analysis confirmed that the mortality risk was higher for males and increased with age and decreased over time. The patients' main characteristics changed over time and, along with a greater presence of women and non-natives, fewer marginalised people and more socially integrated people turned to CATs. CONCLUSIONS: The mortality risk in treated AUD is confirmed to be higher when compared with the general population, although it is decreasing. In addition, there is enough epidemiological data to assert that, independent of age and gender, the major causes of death in AUD patients are cancers, gastrointestinal disease, cardiovascular disease (CVD), and injuries

Accesses for alcohol intoxication to the emergency department and the risk of re-hospitalization: An observational retrospective study

Background Alcohol use disorders (AUD) are a frequent cause of admission to emergency departments (EDs) for acute alcohol intoxication (AAI). Patients with AUD present a higher risk of readmission to EDs for AAI than the general population, however, the distinction between sporadic AAI and AAI in the context of AUD in the ED setting is difficult. Aims To analyze the epidemiological characteristics of patients admitted to EDs because of AAI and to identify factors associated with repeated admissions in order to develop a risk stratification system for patients with AUD based on objective data that can be easily applied in an ED setting. Methods An observational retrospective study was performed. All patients with diagnosis of AAI at admission in 2014 were enrolled. Results Five hundred and sixty-five patients were enrolled, of which 92 (16%) were admitted more than once to the ED. At multivariate analysis, factors associated with readmission were past episodes of alcohol abuse, social discomfort, previous traumas and psychiatric disorders. Basing on this parameter, a risk-score for re-hospitalization was developed. This score has a high predictive power for the risk of readmission to the ED (AROC 0.837, 95%CI 0.808–0.866), moreover, the cumulative probability of readmission within one year, increased in parallel with score value, being highest in patients presenting 3 or more risk factors. Conclusion The present study demonstrates that several risk factors stratify the risk of re-hospitalization in patients admitted to EDs for AAI, allowing the identification of those presenting more severe conditions and who would likely benefit from multidisciplinary intervention