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Alcohol: health harm

Introduction

Excessive consumption of alcohol can result in a wide range of health problems. Some may occur after drinking over a relatively short period, such as acute intoxication (drunkenness) or poisoning (toxic effect). Others develop more gradually, only becoming evident after long-term drinking, such as damage to the liver and brain. In addition to causing physical problems, excessive alcohol consumption can lead to mental health problems such as dependency.

Alcohol-related general and psychiatric hospital discharges

Alcohol-related hospital discharge statistics are published annually by Information Services Division of NHS National Services Scotland. The latest report, Alcohol Related Hospital Statistics 2015/16 (650 KB), was published on the 25th of October 2016. Some key points from this publication are:

  • In 2015/16 there were almost 35,000 alcohol-related inpatient hospital admissions in Scotland. Over this period around 23,400 Scottish residents had at least one admission to hospital with an alcohol-related condition, of whom around 11,400 had not been admitted in the previous 10 years or were admitted for the first time.

  • In 2015/16 the rate of alcohol-related inpatient stays are similar to the previous year, reducing by less than 2%. Overall, there has been a steady decline in alcohol-related hospital stays since 2008/09 both in general acute hospitals and in psychiatric hospitals.

  • In recent years, there has been an increase in hospital admissions for alcoholic liver disease and alcohol withdrawal state during a period where overall alcohol-related admissions have been decreasing.
  • In recent years, there has been an increase in the number of people having multiple alcohol-related admissions within a year. This may be contributing to the slowing of the overall decreasing trend in alcohol-related admissions.

  • There continues to be an inequality gap for alcohol-related admissions between those living in the most and least deprived parts of Scotland.

The rate of alcohol-related hospital stays will vary between different geographical areas in Scotland. Information by NHS Boards and Alcohol & Drug Partnerships can be found in the ScotPHO Alcohol Profiles

Primary care consultations

Practice Team Information (PTI) was a system that collected consultation data from general medical practices in Scotland. Data were collected from a sample of practices covering 6% of the Scottish population and included every face-to-face contact between a patient registered with the practice and a member of the practice team. This sample was broadly representative of the Scottish population in terms of age, sex, deprivation and urban/rural mix and allowed consultation estimates to be produced for Scotland. The estimates reported here are based on recording of Read codes directly attributable to alcohol therefore are likely to be an underestimate of the total burden of morbidity due to alcohol in primary care. As of September 2013, PTI data is no longer collected. 2012/13 is the last year for which ISD will be able to publish annual PTI data.

SPIRE is a service that will allow small amounts of information from GP practice records to be used to help doctors’ surgeries, NHSScotland and the Scottish Government to improve care and plan services, and to help researchers to learn more from patient information held at GP practices.  For further information, please refer to the SPIRE website.

The most recent PTI figures on numbers of alcohol-related consultations, patients seen for alcohol-related conditions and their co-morbidity, their age and gender and deprivation can be found in these Excel tables: Alcohol-Primary-Care-2012-13.xls (78Kb). Key points are: 

  • In 2012/13, there were an estimated 94,630 alcohol-related primary care consultations by 48,420 patients, a substantial fall from 109,170 consultations by 57,470 patients in 2011/12.

  • Forty-six percent of the patients seen for alcohol misuse in 2012/13 were aged between 45 and 64, but consultation rates were highest for those aged 65 years and over.

  • In patients aged between 18 and 44 who consulted their GP for alcohol misuse in 2012/13, men were more than twice as likely to consult for anxiety or for depression compared to all males who consulted a GP, whereas females were around three times more likely to consult for anxiety or for depression compared with all females who consulted a GP.

  • There were two-and-a-half times more patients consulting for alcohol misuse in the most deprived quintile compared with the least deprived quintile. 

Mortality and morbidity partly attributable to alcohol

Alcohol is linked to many disease conditions and is one of the major risk factors for burden of disease in established market economies. These conditions may be acute or chronic diseases or injuries. In order to measure the total burden of morbidity and mortality attributable to alcohol, all these conditions must be identified and the proportion attributable to alcohol calculated. Conditions where alcohol is 100% contributory include alcoholic liver disease, mental and behavioural disorders due to use of alcohol, etc. Partly attributable conditions include for example Cancer of the lip, oral cavity and pharynx, coronary heart disease and stroke. The proportions of these conditions attributable to alcohol (the population attributable fractions or PAF) can be identified from literature reviews and/or primary analysis. For a particular disease or injury it can be interpreted as the proportion of the total cases that would not have occurred in the absence of exposure to the risk factor.

Alcohol PAFs for Scotland were calculated using the best possible estimates based on the current evidence available in the epidemiological literature, augmented where necessary by primary data and specific estimates of population drinking in Scotland from the 2003 Scottish Health Survey. These were then applied to mortality and morbidity data to estimate more fully the burden of alcohol attributable harm in Scotland. The results can be found in the ScotPHO report, Alcohol attributable mortality and morbidity: alcohol population attributable fractions for Scotland.

Alcohol has been found to be a consistent factor in the admission of trauma patients who require to spend 3 or more days in hospital or who die as a result of their injury. The Scottish Trauma Audit Group (STAG) publishes information on trauma admissions where there was evidence that alcohol was implicated. Between 2011 and 2015 that alcohol was involved in around 1 in 5 of minor trauma patients-, and around 1 in 3 of major trauma patients who met the STAG entry criteria. Alcohol was either ingested by the trauma patient or another person involved in the trauma incident. Between 2011 and 2015, alcohol was more than twice as likely to be a factor in male trauma patients compared to female patients (15% vs 6% respectively) see Table 2.5. More information on the STAG inclusion criteria can be found at www.stag.scot.nhs.uk.

Alcohol-related deaths

National Records of Scotland (NRS) annually publish information on the numbers of deaths which are classified as 'alcohol-related' on the basis of the current definition (which was agreed with the Office for National Statistics and the Northern Ireland Statistics and Research Agency in 2006). Further information on the coverage of alcohol related death statistics is available on the NRS website.

NRS also produce some age standardised deaths rates for certain selected causes which includes alcohol-related deaths.

A summary of the key points from the latest report, Alcohol-related deaths in Scotland, 1979 to 2015, is provided below:

  • In 2015, there were 1,150 alcohol-related deaths, on the basis of the current definition. There has been little change compared to 2014 when the number of deaths was 1,152.

  • Over the years since 1979, there have been roughly twice as many male deaths as female deaths. Of the alcohol-related deaths in 2015, 764 (66%) were male deaths and 386 (34%) were female deaths
  • In 2015, the largest proportion of  alcohol-related deaths 43% (491) occurred in those aged 45-59 years followed by 36% (412) occurring in those aged 60-74 years.  The number of deaths in these age groups has increased over the previous three years at a time when deaths have fallen or remained the same for other age groups.

  • In 2015, there were 130 alcohol-related deaths in those aged 30-44 years; this is the lowest number of deaths for this age group since 1995.

  • A small proportion of alcohol-related deaths occur in those aged under 30 years, usually around 1-2% since 1979.

  • In 2015, 9% (108) of alcohol-related deaths occurred in those aged 75 and over.  The number has decreased by 8% since 2014 but is still almost double the number of deaths occurring in this age group in 1995.

  • Tables 2 and 3 give figures for each NHS Board area and council. As the figures can fluctuate markedly from year to year, 3-and 5-year averages are shown for NHS Boards and 5-year averages are shown for councils. This should indicate better any overall trend.

  • In 2015 there were 6,813 alcohol-related deaths in England, this is a decrease from 2014 (6,831). While Scotland had the highest alcohol-related death rate in 2015, it was the only constituent country of the UK with significantly lower rates than 10 years ago. However please note that the ICD 10 codes used for the analysis in England vary from ISD methods. These issues should be taken into account when comparing the figures. 

The MESAS Annual Reports also include information on alcohol-related deaths, for example broken down by gender (Fig 8) and deprivation decile (Fig 9B in the MESAS Final Annual Report (2.4 MB)).

Local data on alcohol-related mortality can be found in the ScotPHO Alcohol Profiles.

Please note: If you require the most up-to-date data available, please check the data sources directly as new data may have been published since these data pages were last updated. Although we endeavour to ensure that the data pages are kept up-to-date, there may be a time lag between new data being published and the relevant ScotPHO web pages being updated.

Page last updated: 15 September 2017

© Scottish Public Health Observatory 2014