Socio‐economic inequities in emergency department visits for wholly alcohol‐attributable acute and chronic harms in Canada, 2003–2017

Introduction Individuals with low socio‐economic position (SEP) experience disproportionate alcohol‐attributable harm. Limited research has investigated whether these inequities are driven by alcohol‐attributable conditions that are acute or chronic. The study aimed to estimate the sex‐specific associations between SEP and incident wholly alcohol‐attributable emergency department (ED) visits for acute and chronic harms, respectively. Methods A cohort study was conducted using the Canadian Community Health Survey (2003–2008) linked to the National Ambulatory Care Reporting System (2002–2017) in Alberta and Ontario. SEP was measured using educational attainment. Acute and chronic ED visits were captured in the National Ambulatory Care Reporting System follow‐up data. Hazard models were fit to estimate the association between SEP and acute and chronic wholly alcohol‐attributable ED visits. Results The analytical sample included 88,865 respondents. In men and women, individuals with lower SEP had increased hazard of acute ED visits (women hazard ratio [HR] 1.75, 95% confidence interval [CI] 1.07–2.87; men HR 3.47, 95% CI 2.29–5.25) and chronic ED visits (women HR 2.24, 95% CI 1.04–4.80; men HR 5.02, 95% CI 2.88–8.75). Acute and chronic wholly alcohol‐attributable ED visit rates were higher in men than women. Discussion and Conclusions The findings indicated lower SEP was associated with greater harms for both acute and chronic wholly alcohol‐attributable ED visits when compared to their higher SEP counterparts. We conclude that gradients in SEP are associated with acute and chronic harms. These results highlight a need for equitable interventions that reduce the absolute burden of inequities in both acute and chronic wholly alcohol‐attributable ED visits.