Accesses to ER for Alcohol and Drugs Related Conditions among Foreigners in Rome, 1999-2014

Background: Alcohol and drugs abuse and dependence are a well-known issue for foreign populations. The aim of this study was to characterize the admissions to the emergency room of three hospitals of Rome from 1999 to 2014 for these conditions and to highlight the differences between Italian citizens and foreigners. The impact of educational level (EL), with respect of the nationality, was also investigated. Methods: Adult patients were divided in 23 Nationality Groups (NGs). Poisson regression model was used to estimate incidence rate ratios (IRRs) of the different groups for: abuse of alcohol and drugs (ICD9-CM 305), their dependence (ICD9-CM 303, 304) and induced mental disorders (ICD9-CM 291, 292), as a whole. Results: In the period of interest, 51.007 (2,2%) patients received a diagnosis of mental disorders after the access to ER. Of these, 8.575 (17,0%) were classified as abuse or dependence of alcohol or drugs or as induced mental disorders. The analysis showed that almost all NGs have a higher risk than Italians to receive these diagnoses, with the exception of South-Eastern Asia, that have a lower risk, and Middle and Southern Africa, Central America, Central Asia and Eastern Asia, which had the same risk. The introduction of the EL in this model showed a sharp decreasing trend of the risk with the increase of the EL itself, with no or little effect on the risk estimate of each NG. Conclusions: The burden of substances abuse is widespread among foreign populations, not only for those mainly composed by tourists (Northern America, Australia and New Zealand), but also for migrant populations, with the exception of Asians. The little effect of the EL may reflect a scarce reliability of the EL itself as an indicator of socio-economic status for less integrated populations. Targeted culture-tailored interventions should be implemented to reach these vulnerable populations.