Let's talk facts when discussing the impact of alcohol in emergency departments
1 August 2019
LIES, damned lies and statistics as the saying goes. It's easy to get lost in them. Yet Australians' bulldust barometers are well tuned, our innate common sense usually spies the bit that doesn't add up.
Much has been made in the Canberra Times recently of the Driving Change snapshot survey of emergency departments. Data collected from just nine EDs, two in the ACT, over two months relying on some flimsy science.
Driving Change in Canberra found: "Overall, between 3.7% (Calvary) and 5.6% (TCH) of all attendances had consumed alcohol in the preceding 12 hours. On Friday and Saturday nights, alcohol attendances increased to 15.8% at Calvary, and 13.5% at TCH (8pm-6am)".
The study parameters assert anyone who had a drink at, say, lunch, even one beer, and is in an ED up to 12 hours later, that alcohol was a contributing factor.
Such a loose hypothesis needs to be called out.
Humans metabolise alcohol at an average rate of one standard drink per hour. So even a full-strength stubby, at 1.2 standard drinks, will typically leave a person's system in 1.2 hours.
So it's very odd to judge alcohol-related harm based on whether a person had a drink up to 12 hours before presenting in emergency. It ignores human physiology.
At least for some, perhaps many, of the people identified in the study, alcohol would have left the patient's system possibly many hours prior to their reason for seeking treatment.
It might lead a cynic to think such a low research threshold could be a ploy to inflate the number of cases to fit a narrative.
For all of this, the complete dataset from all Australian hospital EDs tells a different story.
Driving Change advocate Michael Thorn recently stated in this newspaper's pages: "annual reporting on ED presentations by the Australian Institute of Health and Welfare only record primary injuries, such as a broken wrist, not the fact the patient was intoxicated and fell over. Alcohol only gets recorded when it's the primary diagnosis".
In fact, the latest data and literature evidence combined can provide a clearer picture.
Last year Deloitte Access Economics completed the first-ever comprehensive analysis of ED presentations in Australia.
Deloitte not only drilled down into the aggregated Alcohol and Other Drugs data provided by the AIHW, but the AIHW gathered a special dataset from EDs in every hospital in every state and territory.
The AIHW reported that, in 2016-17, the total number of ED presentations nationally due to alcohol abuse and alcohol-induced mental disorders was 46,785 out of 7,755,606 cases in all – or 0.6% of all ED cases.
In the ACT, of the 143,860 ED presentations that year, 765 were reported as alcohol abuse and alcohol-induced mental disorders by the EDs – or 0.53% of all ED cases.
Over recent years, Australia-wide and in the ACT, the proportion of alcohol-related ED presentations has been falling. The dataset will need more time to establish clear trends.
The Deloitte report found from literature evidence that around 2% of injury presentations are alcohol-related, and injury presentations are less than a quarter of ED visits. So adding alcohol-related injuries as a 'secondary' condition might add 0.5% to the 0.6% where alcohol is the 'primary' reason for admission. Overall, that still means the real share is closer to 1% than 15%.
Not for one instant should anyone underplay the issues regarding alcohol harm. They are real and they can be serious. But the official, verifiable facts are also real and you don't get to make up your own.
We know that for the overwhelming majority of Australians alcohol is consumed in moderation as part of a normal, healthy lifestyle.
The Australian Bureau of Statistics tells us that Australians are drinking less alcohol today than at any point in the last 55 years.
We know from both the AIHW and ABS that 84% of Australians drink within recommended guidelines. That's no more than two standard drinks per day.
The AIHW reports that underage drinking is at its lowest point on record, with 82% of Under 18s not drinking at all. Those that have tried a drink are doing so later, and drinking less, than ever before.
No-one has a monopoly on valuing the service of the doctors, nurses and all who work in hospital EDs. They rise to challenges the rest of us cannot imagine.
What we are asking for is some perspective when considering these important issues. Not everything has to be presented as a 'crisis' to effect further change for the better.
Published in The Canberra Times on 1 August 2019. Brett Heffernan is Chief Executive Officer for the Brewers Association of Australia
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