Social outcomes associated with alcohol-related diagnoses: a population-based analysis using linked administrative data IJPDS (2017) Issue 1, Vol 1:260 Proceedings of the IPDLN Conference (August 2016)

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Nathan Nickel Leonard MacWilliam Oke Eukema Heather Prior Joshua Nepon
Published online: Apr 18, 2017


ABSTRACT


Objective
The objective of this population health research is to identify the social burden associated with having an alcohol related diagnosis.


Methods
We used linkable population-based administrative data files held in the Population Health Research Data Repository to conduct our research, fiscal years 1990/91 to 2014/15. Data came from several domains including health, social services, justice, and the Canadian Census. We used ICD-9/10-CA codes from the hospital abstract database, medical claims data, and prescription drug data to identify individuals with an alcohol-related diagnosis. Individuals’ socioeconomic status was determined using neighbourhood-level income data from the Canadian Census. We matched, 3:1, diagnosed cases to individuals in our repository using on age, sex, income, and community area. We linked cases and matches to administrative data from justice and social services to identify social outcomes associated with having an alcohol-related diagnosis. Outcomes included receipt of income assistance, residence in publically funded social housing, having a child apprehended by child and family protective services, having a charge for driving under the influence recorded in the justice data, and having a charge for domestic violence recorded in the justice data. We modelled rates using generalized estimating equations from 5 years before date of diagnosis to a maximum of 20 years after date of diagnosis. Models tested for significant differences in rates between cases and matches both before and after diagnosis; as well, we tested for time trends in rates both before and after diagnosis.


Results
We identified 52,991 individuals with an alcohol related diagnosis between 1990/91 and 2014/15: 34,145 males and 18,846 females. 80.3% of cases had a mental-health related alcohol diagnosis. Diagnoses followed a socioeconomic gradient with the greatest number of cases coming from low-income neighbourhoods. Cases had a significant spike in rates from one year before to one year after diagnosis date, compared with matches, across all indicators. When we followed individuals for 20 years after diagnosis, we found a significantly elevated rate of social service use and involvement with the justice system, across all outcomes, for all years.


Conclusion
Receiving an alcohol-related diagnosis is associated with subsequent increased use of social services and contacts with the justice system. Upstream efforts to reduce alcohol-related diagnoses may result in reduced use of social services and justice contacts.


Background

Realigning Children’s Services is a programme which aims to improve the commissioning and planning of children's services through the use of evidence and implementation science. A key focus of this is an ambitious data linkage project which links two sets of survey data with local administrative data from Education and Social Work in local Community Planning Partnerships (CPPs) within Scotland. The initial tranche for the programme worked with three CPPs in 2015/16 and has involved work at a national and local level.

Aims

The data linkage component to the project has been closely aligned to local need and interest with continued collaboration with professionals in local areas from strategic managers to schools. The data resulting from the linkage will allow for a series of reports tailored to local priorities and will also inform a data visualisation tool which will help professionals to look closely at the data. It has also prompted discussion and reflection within the local areas around what data is currently used in each locality, how evidence can inform their planning and what gaps exist within their knowledge base which could be filled through the data linkage.

Approach

Contribution Analysis was used as a framework to evaluate the effectiveness of the Realigning Children's Services programme. This allowed a focus on far reaching outcome measures alongside process measures through a mix of qualitative and quantitative data. Data from this evaluation will inform future linkage projects and evaluate the use of linked data in strategic planning in children's services.

Conclusion

The Realigning Children's Services programme has shown that data linkage within a children and families context can be complex and ethically challenging. However it also offers professionals access to critical data which can otherwise go overlooked. This presentation will discuss these challenges and consider how this work has been used to help local areas improve their planning of their services for children and families within a multidisciplinary setting.

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