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Abstract
The nature and extent of treated health problems in patients with problems related to the use of alcohol and drugs (including both licit and illicit drugs) were compared with the morbidity levels of all patients treated for all conditions in Canada. The morbidity experience of all patients with alcohol or drug (A/D) diagnoses treated as inpatients (n = 52,200 cases) in all Ontario hospitals in 1985–1986 (based on Hospital Medical Records Institute [HMRI] data) was compared with that of the total population of all inpatients treated in all Canadian hospitals using age-sex standardized morbidity ratios (SMR) and adjusting for multiple diagnoses. Of A/D cases, 32% were admitted with a primary A/D diagnosis and 68% with a secondary A/D diagnosis; 17% of A/D cases had multiple A/D diagnosis. On average, cases with a primary A/D diagnosis had 29% more diagnoses per case than all cases treated in Ontario. SMRs were highest for cases with diagnoses relating to the use or misuse of licit drugs (SMR = 13.32 and 3.51 for those with primary and secondary drug diagnoses, respectively), intermediate for illicit drug cases (SMR = 8.87 vs. 4.74 for primary and secondary diagnoses, respectively), and lowest for patients with alcohol diagnoses (SMR = 6.68 and 4.12 for primary and secondary diagnoses, respectively). Excess morbidity for alcohol cases affected more diagnostic categories and body systems, being at a higher level than for drug cases. Alcohol or drug cases had particularly high SMRs for mental disorders, infectious and parasitic conditions, and injury and poisoning diagnoses. Alcohol or drug cases had reduced reproductive morbidity: for complications of pregnancy, childbirth, and the puerperium, SMR = 0.04 to 0.24 for cases with primary A/D diagnoses and SMR = 0.12 to 0.89 for those with secondary A/D diagnoses. Cases with drug diagnoses had a considerable reduction in SMR for certain conditions originating in the perinatal period: SMR = 0.0 for cases with primary drug diagnoses and SMR = 0.0 for secondary illicit drug diagnoses cases and SMR = 0.18 for secondary licit drug diagnoses cases.
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Notes on contributors
Manuella Adrian
Manuella Adrian received her BA from McGill University (Canada) and her MS Hyg. from the University of Pittsburgh (USA). She teaches in the public health program in the College of Osteopathic Medicine at Nova Southeastern University, Fort Lauderdale, Florida (USA). She was director of research and a senior research scientist for the Kansas Health Institute (USA), head of the Statistical Research Program and a senior scientist at the Addiction Research Foundation of Ontario (Canada), a research economist with the federal department of Health and Welfare Canada, and a policy analyst with the Canadian Ministry of State for Science and Technology. She has consulted for the World Health Organization, the Pan American Health Organization, and the Organization for the Control of Endemic Diseases in Africa. She is currently cross-appointed with the Economics Department at the University of Guelph (Canada), among others. She has over 200 professional publications, is a member of the editorial board of Substance Use and Misuse and is a faculty member of the Middle Eastern Summer Institute on Drug Use. (MESIDU) and the Middle Eastern-Mediterranean Summer Institute on Drug Use (MEMSIDU).
Shawn J. Barry
Shawn J. Barry received his BA and MA degrees in economics at the University of Guelph (Canada). He is a senior analyst with the Wisconsin Department of Health and Family Services in Madison, Wisconsin. He was a research coordinator with the Center for Health Economics and Policy Analysis at McMaster University, manager of the Medical Economics Unit at Alberta Health, and he served as the western Canadian representative for the Canadian health ministries in developing the National Physician Data Base. He was the director of the Financial Research and Planning Division for the Louisiana Department of Health and Hospitals. He was a research associate at the Addiction Research Foundation at the time this work was first undertaken.