Hospital discharges for substance-related injuries before and during the COVID-19 pandemic: a descriptive surveillance study using administrative data

Stephanie Toigo; Steven R. McFaull; Wendy Thompson

doi:10.9778/cmajo.20220164

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Figure 1:
Percent change in age-standardized rates of hospital discharges for injuries (with and without a substance-related diagnosis) from March 2020 to February 2021, compared with March 2019 to February 2020, in Canada (excluding Quebec). Note: CI = confidence interval.
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Figure 2:
Number (bars, left Y axis) and age-standardized rate (lines, right Y axis) of hospital discharges for substance-related injuries in Canada (excluding Quebec) in the prepandemic (March 2019–February 2020) and pandemic (March 2020–February 2021) periods. Age-standardized rates are standardized to the 2011 Canadian population (excluding Quebec). Note: CI = confidence interval.
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Figure 3:
Hospital discharges for substance-related injuries by substance type in the pandemic (March 2020–February 2021) versus the prepandemic (March 2019–February 2020) periods. *Indicates difference in counts with p < 0.05.

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Table 1:

Codes from the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, used for case selection of hospital discharges for substance-related injuries in the Discharge Abstract Database

Type	Codes
Intent of external causes of injuries
Unintentional injuries	V01–V99, W00–W19, W20–W49, W50–W64, W65–W74, W75–W84, W85–W99, X00–X09, X10–X19, X20–X39, X40–X49, X50, X52
Intentional injuries	X60–X84, W84–Y09, Y87 (0.0–0.1)
Substance-related diagnoses
Alcohol only	F10, X45, X65, Y91, T51 (0.0–0.3, 0.8, 0.9), R78.0
Opioids only	F11, Y45, T40 (0.0–0.4, 0.6), R78.1
Cannabinoids only	F12, T40.7
Sedatives or hypnotics only	F13, Y47, T42 (0.3, 0.4, 0.6, 0.7)
Cocaine only	F14, T40.5, R78.2
Other stimulants only	F15, Y49.7, Y50.8, T43.6
Hallucinogens only	F16, T40 (0.8, 0.9), R78.3
Tobacco only	F17, T65.2
Volatile solvents only	F18, X46, X66, T52
Unspecified psychoactive substances	F19, X41–X42, X61–X62, T43 (0.8, 0.9), R78.5
Polysubstance	More than 1 of the above substance categories

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Table 2:

Age-specific rates of hospital discharges for substance-related injuries in Canada (excluding Quebec), before (March 2019–February 2020) and during the first year (March 2020–February 2021) of the COVID-19 pandemic, by injury intent and sex^*

Age groups, yr	Unintentional injuries, rate per 100 000 population (95% CI)				Intentional injuries, rate per 100 000 population (95% CI)

	Male patients		Female patients		Male patients		Female patients

	Prepandemic	Pandemic	Prepandemic	Pandemic	Prepandemic	Pandemic	Prepandemic	Pandemic
< 1	8.2 (3.6–12.9)	9.6 (4.6–14.6)	6.5 (2.2–10.7)	12.1 (6.4–17.9)	0	0	0	0

1–4	17.4 (14.0–20.7)	25.6 (21.6–29.6)^†	16.6 (13.2–19.9)	23.2 (19.3–27.0)	0	0	0	0

5–9	2.9 (1.7–4.1)	7.2 (5.3–9.0)^†	2.1 (1.1–3.1)	6.1 (4.3–7.8)^†	0	0	NA	NA

10–14	3.9 (2.5–5.3)	4.5 (3.0–5.9)	7.3 (5.4–9.2)	8.4 (6.3–10.4)	6.9 (5.1–8.8)	5.8 (4.2–7.5)	46.7 (41.8–51.5)	48.6 (43.7–53.4)

15–19	28.0 (24.5–31.6)	28.1 (24.5–31.6)	23.8 (20.5–27.2)	25.3 (21.9–28.7)	41.7 (37.4–46.0)	34.6 (30.7–38.6)	124.6 (116.9–132.3)	120.0 (112.5–127.4)

20–29	49.2 (46.2–52.3)	59.8 (56.5–63.1)^†	29.5 (27.0–31.9)	35.4 (32.8–38.0)^†	41.1 (38.3–43.8)	38.6 (35.9–41.2)	68.5 (64.8–72.3)	62.5 (59.0–66.0)

30–39	69.3 (65.6–73.0)	84.4 (80.4–88.4)^†	32.7 (30.2–35.3)	39.1 (36.4–41.8)^†	38.3 (35.6–41.0)	40.5 (37.8–43.3)	43.1 (40.2–46.0)	36.8 (34.2–39.5)^†

40–49	58.7 (55.3–62.0)	82.6 (78.4–86.7)^†	32.8 (30.2–35.4)	37.1 (34.3–39.8)	31.8 (29.3–34.3)	32.2 (29.6–34.9)	38.7 (35.8–41.5)	35.1 (32.4–37.8)

50–64	81.8 (78.5–85.1)	102.6 (98.9–106.3)^†	46.5 (44.1–49.0)	45.9 (43.5–48.4)	25.8 (24.0–27.7)	24.3 (22.5–26.1)	31.0 (29.0–33.0)	24.5 (22.7–26.2)^†

65–74	95.0 (89.8–100.3)	102.3 (96.9–107.6)	58.5 (54.5–62.4)	54.7 (51.0–58.4)	14.8 (12.7–16.8)	10.7 (9.0–12.4)^†	15.9 (13.9–18.0)	12.7 (11.0–14.5)

75–84	105.2 (97.3–113.1)	91.2 (84.0–98.4)	80.6 (74.3–86.9)	74.3 (68.4–80.3)	10.7 (8.2–13.2)	9.2 (6.9–11.5)	10.0 (7.7–12.2)	10.9 (8.6–13.2)

≥ 85	118.5 (104.3–132.6)	104.5 (91.4–117.6)	117.8 (107.0–128.5)	98.8 (89.1–108.6)	17.2 (11.8–22.6)	12.8 (8.2–17.4)	9.7 (6.6–12.8)	10.4 (7.3–13.6)

Note: CI = confidence interval, NA = not applicable.
↵* Age-specific rates per 100 000 population were calculated using Statistics Canada population estimates (excluding Quebec) for 2019–2020 and 2020–2021. Rates based on counts between 1 and 5 are not reported (indicated as NA).
↵† Indicates a difference in rates with p < 0.05.