Health service use by exposure groups.

ObjectiveOur objective was to evaluate the association between two types of substance use presentations in the emergency department (ED) (opioid and alcohol) and the subsequent risk of hospital admission.MethodsThe study is a retrospective observational cohort study using administrative data from all patients presenting with substance use disorder (SUD) at Health Sciences North (HSN) from January 1, 2018, to August 31, 2023. Patients were placed in two groups: those with alcohol-related presentations and those with opioid-related presentations. The outcome was the time and number of ED visits between the index ED visit and first admission to the hospital for the substance-related presentation.ResultsA total of 5,240 individuals (45.98%) presented with opioid use, and 6,140 individuals (45.61%) presented with alcohol use. The opioid group was younger (mean age = 36.86 years, compared to 44.58 years in the alcohol group) and had higher rates of current homelessness (37.47% vs. 9.63%), a higher prevalence of mental disorders (15.71% vs. 10.68%), and a greater likelihood of being diagnosed with cellulitis (5.24% vs. 0.52%). Despite similarities in 30-day ED revisits (41.53% for alcohol vs. 40.88% for opioids) and mean length of stay (12.16 days for opioids vs. 10.04 days for alcohol), individuals in the opioid group had a higher likelihood of inpatient admission with each additional ED visit (hazard ratio = 1.28, 95% CI [1.19, 1.37]).ConclusionOur findings highlight the healthcare needs of individuals presenting to the ED with opioid use versus alcohol use, with opioid-related cases involving more acute and complex healthcare presentations.

研究目标
本研究旨在评估急诊室（Emergency Department, ED）内两类物质使用就诊情况（阿片类与酒精类）与后续住院风险之间的关联。

研究方法
本研究为回顾性观察队列研究，采用北健康科学中心（Health Sciences North, HSN）2018年1月1日至2023年8月31日期间所有因物质使用障碍（Substance Use Disorder, SUD）就诊患者的行政医疗数据。将患者分为两组：酒精相关就诊组与阿片类相关就诊组。结局指标为从首次急诊就诊至因该物质相关情况首次入院的间隔时长与急诊就诊次数。

研究结果
共计5240例（45.98%）患者为阿片类物质使用就诊者，6140例（45.61%）为酒精类物质使用就诊者。阿片类组患者年龄更小（平均年龄36.86岁，酒精组为44.58岁），当前无家可归比例更高（37.47% vs. 9.63%），精神障碍患病率更高（15.71% vs. 10.68%），且蜂窝织炎诊断率更高（5.24% vs. 0.52%）。尽管两组30天内急诊复诊率（酒精组41.53%，阿片类组40.88%）与平均住院时长（阿片类组12.16天，酒精组10.04天）无显著差异，但阿片类组患者每增加一次急诊就诊，住院风险均更高（风险比=1.28，95%置信区间（Confidence Interval, CI）[1.19, 1.37]）。

研究结论
本研究结果凸显了急诊就诊的阿片类物质使用患者相较于酒精类使用患者的医疗需求差异，阿片类相关病例的医疗就诊表现更为紧急且复杂。