Trends in alcohol-related admissions to hospital by age, sex and socioeconomic deprivation in England, 2002/03 to 2013/14

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Abstract

Background

Prevalence of alcohol-related harms in England are among the highest in Europe and represents an important policy issue. Understanding how alcohol-related trends vary by demographic factors is important for informing policy debates. The aim of our study was to examine trends in alcohol-related admissions to hospital in England, with a focus on variations by sex, age and socioeconomic deprivation.

Methods

We used data on hospital admissions for England for the financial years 2002/03 to 2013/14. Our four main outcome variables were acute and chronic conditions wholly and partially attributable to alcohol consumption. We also looked at four specific conditions wholly attributable to alcohol. Socioeconomic deprivation was measured using the English Indices of Deprivation of a patient’s residence (categorised by quintile). We calculated crude rates, age-specific rates (visualised by Lexis plots) and directly standardised rates by deprivation category, separately for males and females.

Results

Total admissions for all alcohol-attributable admissions increased from 201,398 in 2002/03 to 303,716 in 2013/14. The relative increase of these admissions was larger than compared to non-alcohol attributable admissions. Acute admissions wholly attributable to alcohol had the largest relative increase of our outcome measures, and displayed a bimodal distribution with higher rates in adolescence/young adults and middle age. Chronic conditions wholly attributable to alcohol were concentrated in middle age (particularly males). While admission rates were generally higher for males, females had higher rates of hospitalisations due to ‘Intentional self-poisoning due to alcohol’. We also found evidence of wide social inequalities by level of deprivation, which were wider for men than compared to women across all of our outcome measures other than ‘Intentional self-poisoning due to alcohol’.

Conclusions

Our study expands the evidence base to help understand population level trends in alcohol-related admissions by age, sex and socioeconomic deprivation. There have been increasing hospital admissions attributable to alcohol between 2002/03 and 2013/14, particularly concentrated in middle aged males and deprived areas. However, the increase in young females being admitted for ‘Intentional self-poisoning due to alcohol’ raises additional concerns.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4265-0) contains supplementary material, which is available to authorized users.

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Most cited references 26

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Relationship between alcohol-attributable disease and socioeconomic status, and the role of alcohol consumption in this relationship: a systematic review and meta-analysis

Lisa Jones, Geoff Bates, Ellie McCoy … (2015)

Background Studies show that alcohol consumption appears to have a disproportionate impact on people of low socioeconomic status. Further exploration of the relationship between alcohol consumption, socioeconomic status and the development of chronic alcohol-attributable diseases is therefore important to inform the development of effective public health programmes. Methods We used systematic review methodology to identify published studies of the association between socioeconomic factors and mortality and morbidity for alcohol-attributable conditions. To attempt to quantify differences in the impact of alcohol consumption for each condition, stratified by SES, we (i) investigated the relationship between SES and risk of mortality or morbidity for each alcohol-attributable condition, and (ii) where, feasible explored alcohol consumption as a mediating or interacting variable in this relationship. Results We identified differing relationships between a range of alcohol-attributable conditions and socioeconomic indicators. Pooled analyses showed that low, relative to high socioeconomic status, was associated with an increased risk of head and neck cancer and stroke, and in individual studies, with hypertension and liver disease. Conversely, risk of female breast cancer tended to be associated with higher socioeconomic status. These findings were attenuated but held when adjusted for a number of known risk factors and other potential confounding factors. A key finding was the lack of studies that have explored the interaction between alcohol-attributable disease, socioeconomic status and alcohol use. Conclusions Despite some limitations to our review, we have described relationships between socioeconomic status and a range of alcohol-attributable conditions, and explored the mediating and interacting effects of alcohol consumption where feasible. However, further research is needed to better characterise the relationship between socioeconomic status alcohol consumption and alcohol-attributable disease risk so as to gain a greater understanding of the mechanisms and pathways that influence the differential risk in harm between people of low and high socioeconomic status. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1720-7) contains supplementary material, which is available to authorized users.

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Alcohol consumption and social inequality at the individual and country levels--results from an international study.

Ulrike Grittner, Sandra Kuntsche, Gerhard Gmel … (2013)

International comparisons of social inequalities in alcohol use have not been extensively investigated. The purpose of this study was to examine the relationship of country-level characteristics and individual socio-economic status (SES) on individual alcohol consumption in 33 countries. Data on 101,525 men and women collected by cross-sectional surveys in 33 countries of the GENACIS study were used. Individual SES was measured by highest attained educational level. Alcohol use measures included drinking status and monthly risky single occasion drinking (RSOD). The relationship between individuals' education and drinking indicators was examined by meta-analysis. In a second step the individual level data and country data were combined and tested in multilevel models. As country level indicators we used the Purchasing Power Parity of the gross national income, the Gini coefficient and the Gender Gap Index. For both genders and all countries higher individual SES was positively associated with drinking status. Also higher country level SES was associated with higher proportions of drinkers. Lower SES was associated with RSOD among men. Women of higher SES in low income countries were more often RSO drinkers than women of lower SES. The opposite was true in higher income countries. For the most part, findings regarding SES and drinking in higher income countries were as expected. However, women of higher SES in low and middle income countries appear at higher risk of engaging in RSOD. This finding should be kept in mind when developing new policy and prevention initiatives.

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Do consequences of a given pattern of drinking vary by socioeconomic status? A mortality and hospitalisation follow-up for alcohol-related causes of the Finnish Drinking Habits Surveys.

T Paljärvi, Jyrki Mäkelä (2008)

Socioeconomic differences in alcohol-related mortality and hospitalisations, as based on register data, are larger than socioeconomic differences in various types of harmful drinking, as based on survey data. The aim was to use a follow-up study to examine whether differential drinking patterns between socioeconomic groups explain the observed differences in alcohol-related mortality and hospitalisations, or whether similar drinking patterns predict higher mortality among lower socioeconomic groups. The study population included Finns who participated in cross-sectional surveys on drinking habits in 1969, 1976 or 1984 when aged 25-69 (n = 6406). They were followed up for alcohol-related mortality and hospitalisations (n = 180) for 16 years. Drinking patterns were measured by total consumption, frequency of subjective intoxication and of drinking different amounts of alcohol at a time, and by volume of consumption that was drunk in heavy drinking occasions and non-heavy drinking occasions. Compared with non-manual workers, manual workers had a 2.06-fold hazard of alcohol-related death or hospitalisation. Adjustment for drinking patterns explained only a small fraction of the excess hazard among manual workers. Additionally, in each category of total consumption and in each level of the volume drunk in heavy drinking occasions, the risk of alcohol-related death and hospitalisation was higher for manual than for non-manual workers. Consequences of similar drinking patterns are more severe for those with lower socioeconomic status. Future studies are needed to explain how higher socioeconomic groups manage to escape the consequences of drinking that others have to face.

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Author and article information

Contributors

Mark A Green: mark.green@liverpool.ac.uk

Mark Strong: m.strong@sheffield.ac.uk

Lucy Conway: lucy.conway@phe.gov.uk

Ravi Maheswaran: +44 114 222 0681 , r.maheswaran@sheffield.ac.uk

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 8 May 2017

Publication date PMC-release: 8 May 2017

Publication date Collection: 2017

Volume: 17

Electronic Location Identifier: 412

Affiliations

[1 ]ISNI 0000 0004 1936 8470, GRID grid.10025.36, Department of Geography & Planning, , University of Liverpool, ; Liverpool, UK

[2 ]ISNI 0000 0004 1936 9262, GRID grid.11835.3e, Public Health GIS Unit, School of Health and Related Research (ScHARR), , University of Sheffield, ; Regent Court, 30 Regent Street, Sheffield, S1 4DA UK

[3 ]ISNI 0000 0001 2196 8713, GRID grid.9004.d, , Public Health England, ; London, UK

Article

Publisher ID: 4265

DOI: 10.1186/s12889-017-4265-0

PMC ID: 5423017

PubMed ID: 28482876

SO-VID: eb5b3b75-4c60-4a0d-863b-b4c2d057f4ea

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 13 August 2016

Date accepted : 12 April 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000280, Alcohol Research UK;

Award ID: R 2014/03

Award Recipient : Ravi Maheswaran

Funded by: FundRef http://dx.doi.org/10.13039/501100000272, National Institute for Health Research;

Award ID: PDF-2012-05-258

Award Recipient : Mark Strong

Custom metadata

ScienceOpen disciplines: Public health

Keywords: alcohol-related disorders,alcohol-induced disorders,trends,alcoholic liver diseases,population characteristics,poverty,england

Data availability:

ScienceOpen disciplines: Public health

Keywords: alcohol-related disorders, alcohol-induced disorders, trends, alcoholic liver diseases, population characteristics, poverty, england

Trends in alcohol-related admissions to hospital by age, sex and socioeconomic deprivation in England, 2002/03 to 2013/14

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Most cited references 26

Relationship between alcohol-attributable disease and socioeconomic status, and the role of alcohol consumption in this relationship: a systematic review and meta-analysis

Alcohol consumption and social inequality at the individual and country levels--results from an international study.

Do consequences of a given pattern of drinking vary by socioeconomic status? A mortality and hospitalisation follow-up for alcohol-related causes of the Finnish Drinking Habits Surveys.

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