Estimation of tobacco- or alcohol-attributable disease rates in national hospital care: An Approach based on routine in-patient disease register data and systematic diagnosis of alcohol use disorders

Aims: The goal of this paper was to estimate and compare the numbers and rates of tobacco- or alcohol-attributable disease (TAAD) in in-patient-treated cases in a high tobacco smoking and alcohol consumption country, based on different estimates. Methods: TWo samples, three TAAD estimates, and tobacco- or alcohol-attributable fractions were used. Sample 1 included all disease cases aged 25-64 years and treated more than 24 h as in-patients during the year 1997 (n = 7 344 079) in the hospitals in Germany. Sample 2 included all in-patients aged 25-64 years (n = 1136) consecutively admitted to one general hospital. The first estimate of the TAAD was the routine main diagnosis based on the treating physician's report to the in-patient disease register (IDR) in sample 1. The second estimate included up to three routine treatment diagnoses in sample 2, and the third estimate a diagnosis of alcohol dependence or misuse according to DSM-III-R or ICD-10, as well as harmful or hazardous alcohol consumption, in sample 2. The tobacco-and alcohol-attributable fractions were calculated based on the method for the estimation of tobacco- and alcohol-attributable mortality, originally provided for the Centers for Disease Control in the USA. Results: When the three estimates were combined, a total of 37.8% of all in-patient treatment cases had at least one diagnosis that was attributable in part or fully to tobacco smoking, alcohol dependence, alcohol misuse, or harmful or hazardous alcohol drinking. When the tobacco- and the alcohol-attributable fractions were considered, of all treatment cases, 10.5% could be revealed as attributable to smoking or alcohol consumption according to the one main diagnosis based on the IDR. When all three estimates were combined, the rate was 30.2%. This corresponded to 32.2% of the national in-patient hospital care costs. Conclusions: The TAAD rate is underestimated when using one routine diagnosis alone. Additional alcohol misuse or dependence diagnoses are needed, which may be obtained with a reasonable level of resources in a sample of hospitals. TAAD rates may be used for the planning and practice of brief intervention and as an outcome measure for population-based intervention.