Page last updated: 30-JUN-2009

Alcohol ScotPHO

Statistical Publication Notice

30 June 2009

Alcohol attributable mortality and morbidity: alcohol population attributable fractions for Scotland

INTRODUCTION

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 diseases, acute or chronic, 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. Studies have been undertaken in many countries including the US, Canada, Australia and England to determine the harm caused by alcohol to society. These studies have estimated the disease burden and consequences of alcohol consumption through the calculation of population attributable fractions (PAFs). The aim of this study was, for the first time, to calculate alcohol PAFs for Scotland, using the best possible estimates based on the current evidence available in the epidemiological literature and specific estimates of population drinking in Scotland. These have been applied to mortality and morbidity data for 2003 to estimate more fully the burden of alcohol related harm in Scotland.

KEY POINTS

  1. The study is the first of its kind for Scotland based on Scottish consumption data.
  2. The study more accurately estimates the burden of harm from alcohol problems compared with current routine reporting.
  3. Fifty three conditions were identified where alcohol plays a contributory role.
  4. 1 in 20 (2,882) deaths in Scotland in 2003 were estimated to be attributable to alcohol, twice as many as previously routinely reported.
  5. Alcohol problems also cause a considerable burden to the health care system, accounting for over an estimated 1 in 20 of all patient discharges in 2003.

INTERPRETATION

  • Conditions are identified where alcohol use is a risk factor (i.e. drinking alcohol leads to an increased likelihood of developing the condition).
  • Assessment of this likelihood is based on set epidemiological criteria (namely consistent findings across studies; established biological mechanisms; strength of the association, temporality (cause before effect) and dose response).
  • The risk for each condition at varying levels of alcohol consumption is quantified (relative risk) and combined with information on levels of alcohol consumption in the Scottish population derived from the updated 2003 Scottish Health Survey. (http://www.scotland.gov.uk/Publications/2008/06/25104309/0).
  • This calculates a population attributable fraction (the proportion of cases in the Scottish population attributable to alcohol).
  • This proportion is applied to the number of events (e.g. deaths) for that given condition and the numbers attributable to alcohol calculated.
  • It is recommended that PAFs produced in this report are updated when the 2008 Scottish Health Survey is published.

DETAILED FINDINGS

The study more accurately estimates the burden of harm from alcohol problems compared with current routine reporting
  • 53 conditions identified where alcohol plays a contributory role.
  • Includes conditions not currently reported in routine alcohol statistics e.g. injuries, cancers.
1 in 20 (2,882) deaths in Scotland in 2003 were estimated to be attributable to alcohol, twice as many as previously reported
  • 2,882 (5%) of all deaths in Scotland in 2003 were estimated to be attributable to alcohol.
  • This is twice as many as previously reported in 2003 (1,525) based on wholly attributable conditions.
Men were more likely to die an alcohol attributable death
  • Alcohol attributable deaths varied by gender: men were more at risk of dying, 6.8% of all male deaths were estimated to be alcohol attributable compared to 3.3% for women
Deaths were proportionately higher in younger age groups with 1 in 4 of men and 1 in 5 of women aged 35-44 dying an alcohol attributable death
  • Alcohol attributable deaths also varied by age: over one in four (26.1%) of deaths in men and one in five of deaths (21.1%) in women aged 35-44 years old in 2003 were estimated to be attributable to alcohol consumption. 
  • This compares to 2.0% (271/13,717) and 1.1% (239/20,966) in men and women aged 75 and over respectively.
  • Over a thousand deaths were in people under the age of 55 (1080).
Younger people were more likely to die from an acute consequence (such as injury) whereas older people were more likely to die from a chronic condition. However, 1 in 10 of all deaths in those aged 35-44 were due to alcoholic liver disease.
 
1,492 deaths were estimated to have been prevented by lower alcohol consumption, mainly from CHD in older age groups
  • The protective effect is only at lower levels of consumption. At higher levels there is a negative effect.
  • Some studies suggest that there is no beneficial effect of alcohol consumption on CHD after the age of 75. If we had applied an age cut-off at 75 for CHD, for example, the number of CHD preventable deaths overall would have halved (from 1442 to 794. This would give an overall preventable mortality figure of 844.
  • Drinking at lower levels will also put an individual at risk from other conditions. Risk for conditions, such as some cancers, are elevated even at lower levels of consumption.
Alcohol problems also cause a considerable burden to the health care system, accounting for over 1 in 20 of all patient-specific (hospital) discharges in 2003
  • In 2003, there were 41,414 patient-specific discharges estimated to be attributable to alcohol consumption, accounting for over one in twenty (7.3%) of all patient-specific discharges in Scotland among adults aged 16 and over.
  • This is 50% higher than routine statistics which are based on wholly attributable conditions.
Men were more likely to have an alcohol attributable hospital discharge than women, 1 in 10 of all male discharges in Scotland were estimated to be  alcohol attributable compared to 1 in 20 for women
  • male patient-specific discharges from alcohol attributable conditions accounted for 9.9% of all male patient-specific discharges in Scotland in 2003, compared to 5.1% of female patient-specific discharges.


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MAIN CONTACTS:

Ian Grant
Principal Researcher
ian.grant@nhs.net

Dr Lesley Graham
Associate Specialist
Lesley.Graham@nhs.net
 
Anthea Springbett
Principal Information Analyst
Anthea.Springbett@nhs.net

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GLOSSARY:

Population attributable fraction: an indirect quantification of morbidity and mortality due to a specified risk factor. 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
Relative Risk: the risk of an event (or of developing a disease) relative to exposure to a risk factor
Wholly attributable alcohol condition: a condition where alcohol is implicated in all cases of the condition; for example, alcohol-induced behavioural disorders and alcoholic liver cirrhosis
Partly attributable alcohol condition: where alcohol is causally implicated in a proportion but not all cases of the condition.
Patient-specific discharge rate: the number of individuals discharged from hospital in a given year
 
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PRE-RELEASE ACCESS TO THIS PUBLICATION WAS GIVEN TO:

Under terms of the "Pre-Release Access to Official Statistics (Scotland) Order 2008", ISD are obliged to publish information on those receiving Pre-Release Access ("Pre-Release Access" refers to statistics in their final form prior to publication). The standard maximum Pre-Release Access is five working days. Shown below are details of those receiving standard Pre-Release Access and, separately, those receiving extended Pre-Release Access.
 
Standard (five day) Pre-Release Access:
Scottish Government Health Department (Analytical Services Division)
NHS Board Chief Executives
NHS Board Communication leads
 
Extended Pre-Release Access:
Scottish Government Health Department (Analytical Services Division)
This extended Pre-Release Access is given to a small number of named individuals in the Scottish Government Health Department (Analytical Services Division). This Pre-Release Access is for the sole purpose of enabling that department to gain an understanding of the statistics prior to briefing others in Scottish Government (during the period of standard Pre-Release Access).
 
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HISTORY OF THIS PUBLICATION:

First publication

 


Main contact: Email Ian Grant