"Identifying Information: Name","Hospitalizations Entirely Caused by Alcohol"
"Identifying Information: Short/Other Names","100% Alcohol-Attributable Hospitalizations (AAHs)"
"Identifying Information: 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)."
"Background, Interpretation and Benchmarks: 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 helpBring awareness to the seriousness of harm associated with alcohol useEstimate 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 preventionIdentify 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 useDrive action to reduce and prevent the burden of alcohol harm by informing alcohol policy and priority areas of needMonitor the effectiveness of alcohol policies in place."
"Background, Interpretation and Benchmarks: Interpretation","Lower rates are desirable."
"Background, Interpretation and Benchmarks: HSP Framework Dimension","Improve health status of Canadians"
"Background, Interpretation and Benchmarks: Areas of Need","Staying ºìÁì½í¹Ï±¨y"
"Background, Interpretation and Benchmarks: Targets/Benchmarks","Not applicable"
"Available Data Years","2015
 to 2023"
"Available Data Years: Type of Year",Fiscal
"Availability of Results: Geographic Coverage","All provinces/territories"
"Reporting Level/Disaggregation",National
"Result Updates: Indicator Results","Web Tool:Your ºìÁì½í¹Ï±¨ System: In DepthPDF:Accessing Indicator Results on Your ºìÁì½í¹Ï±¨ System: In Depth (PDF)"
"Update Frequency","Every year"
"Result Updates: Latest Results Update Date","December 2024"
"Result Updates: Updates","Not applicable"
"Indicator Calculation: 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"
"Indicator Calculation: Type of Measurement",Rate
"Indicator Calculation: Number or 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"
"Numerator: Inclusions:","Sex recorded as male or femaleDischarge from a general or psychiatric hospital, or a day surgery clinic.The following codes were used to identify conditions wholly attributable to alcohol:  Outside QuebecInpatient 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); orRecords from the Ontario Mental ºìÁì½í¹Ï±¨ 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 QuebecInpatient 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)."
"Numerator: 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"
"Method of Adjustment: Direct Standardization - Standard Population","Standard Population:Canada 2011"
"Adjustment Applied",Age-adjusted
"Indicator Calculation: Geographic Assignment","Place of residence"
"Data Sources",DAD
"Quality Statement: 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."
"Quality Statement: Trending Issues","The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5 [ICD-9-CM]) was implemented in the Ontario Mental ºìÁì½í¹Ï±¨ 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."
"Quality Statement: Comments","Indicator results are also available inYour ºìÁì½í¹Ï±¨ System: In BriefºìÁì½í¹Ï±¨ Indicators e-Publication.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."
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