title: The effects of alcohol consumption, psychological distress and smoking status on emergency department presentations in New South Wales, Australia.
abstract: BACKGROUND
  Despite clear links between risky alcohol consumption, mental health problems and smoking with increased morbidity and mortality, there is inconclusive evidence about how these risk factors combine and if they are associated with increased attendance at emergency departments. This paper examines the population-level associations and interactions between alcohol consumption, psychological distress and smoking status with having presented to an emergency department in the last 12 months.
  
  
  METHODS
  This study uses data from a representative sample of 34,974 participants aged 16 years and over from the New South Wales Population Health Survey, administered between 2002 and 2004. Statistical analysis included univariate statistics, cross-tabulations, and the estimation of prevalence rate ratios using Cox's proportional hazard regression model.
  
  
  RESULTS
  Results show that high-risk alcohol consumption, high psychological distress and current smoking were all significantly and independently associated with a greater likelihood of presenting to an emergency department in the last year. Presenting to an emergency department was found to be three times more likely for women aged 30 to 59 years with all three risk factors and ten times more likely for women aged 60 years or more who reported high risk alcohol consumption and high psychological distress than women of these age groups without these risk factors. For persons aged 16 to 29 years, having high-risk alcohol consumption and being a current smoker doubles the risk of presenting to an emergency department.
  
  
  CONCLUSIONS
  The combination of being a high-risk consumer of alcohol, having high psychological distress, and being a current smoker are associated with increased presentations to emergency departments, independent of age and sex. Further research is needed to enhance recognition of and intervention for these symptoms in an emergency department setting in order to improve patient health and reduce future re-presentations to emergency departments.
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia. d.indig@med.unsw.edu.au
authors.forename: Devon
authors.initials: D
authors.lastname: Indig
authors.forename: Margo
authors.initials: M
authors.lastname: Eyeson-Annan
authors.forename: Jan
authors.initials: J
authors.lastname: Copeland
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Conigrave
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012309:Risk-Taking; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D013315:Stress, Psychological / Q000150:complications / Q000453:epidemiology*