The use of acute and preventative medical services by a general population: relationship to alcohol consumption

Aims. To investigate the hypothesis that increasing alcohol consumption is accompanied by increasing use of acute, bur decreasing use of preventative, medical services among the general population. Design and participants. He alth and life-style survey of 41 000 randomly-sampled adults in SE England who self-completed a validated questionnaire covering socio-demographics, a lcohol and tobacco usage and use of acute (A & E department and general pra ctitioner) and preventative (dental, optician, mammography and cervical cyt ology) services: the response rare was 60%. Measurements. Comparative use o f acute and preventative health care services by patients with varying cons umption of alcoholic beverages. This was estimated by the odds ratio for se rvice use, after correcting for the following confounding variables; age, s ocial class, ethnic group, employment status, whether lives with children o r with other adults, whether is a carer, limiting long-term illness, depres sion status, smoking habit and use of private health insurance. Findings. T here was increased use of accident and emergency services by the harmful an d intermediate drinking groups compared with the safe drinking group. Male abstainers attended their A & E departments more frequently than 'safe limi t' drinkers. With respect to preventative services, both male and female ab stainers and harmful drinkers used dental services less than safe limit dri nkers. For females, mammography and cervical cytology services were less fr equently used by abstainers and by harmful drinkers. Conclusions. This stud y supports the generally held view that heavy alcohol consumers are disprop ortionate users of acute medical services but they are relative under-users of preventative medical care services. Alcohol abstainers are also over-us ers of acute services, but under-users of preventative services. These latt er observations are relevant to the claims that moderate alcohol consumers have lower apparent morbidity and mortality rates compared to abstainers.