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Related to: Drinking Behaviour, Alcohol Treatment, Alcohol and Young People, Alcohol and Mental Health , Alcohol and Community Safety, Licensing and the Night Time Economy, Crime and Disorder, Ill Health and DisabilityAnxiety and Depression, Domestic Abuse, Homelessness, Mental Health and Illness, Multiple Unhealthy Lifestyle Behaviours, Major Causes of Mortality, Road Traffic Collisions, Safeguarding Adults, Self-Harm, Substance Misuse, Unintentional Injuries, Wellbeing, Socio-economic Inequality [[Pharmacy Needs Assessment]]

Key Facts:

  • Hospital admissions for alcohol related conditions (broad measure) in B&NES are rising, but remain lower than regional and national rates.
  • People living in the most deprived areas of Bath and North East Somerset are significantly more likely to be admitted for an alcohol related condition than those living in the least deprived areas.

Definitions

Alcohol specific conditions - A condition that is wholly caused by alcohol such as alcoholic liver disease or ethanol poisoning.1

Alcohol attributable conditions - A measure based on research that shows certain conditions (e.g. heart disease, cancers, accidents etc.) are partially caused or exacerbated by alcohol. A fraction is calculated to show how much each condition is influenced by alcohol and applied to all hospital admissions. For example,  the measure stipulates that 1/3 rd of male admissions between the ages of 25 and 34 admitted to hospital with hypertension will be caused by alcohol, therefore every 3 males admitted to hospital with hypertension equals one whole alcohol attributable admission.

Therefore, whilst the number of hospital admissions that occur are real numbers, the fractions are estimates based on national studies. Therefore if something happened that caused more people to, for example, start falling (say a particularly icy winter) then it would cause the number of hospital admissions to increase and thus the alcohol attributable admissions to rise even though, in this case, it was unrelated to alcohol.2

Alcohol-related conditions – include all alcohol-specific conditions, plus those where alcohol is causally implicated in some but not all cases of the outcome, for example hypertensive diseases, various cancers and falls. 3

What does the data say?

Hospital admission episodes with alcohol-related conditions in Bath and North East Somerset  (2009/10 – 2013/14)

Broad Measure 4

This section relates to the broad measure of hospital admission episodes with alcohol-related conditions. This broad measure includes the primary diagnosis or any secondary diagnosis.

The hospital admission episodes with alcohol-related conditions (broad measure) rate per 100,000 of the Bath and North East Somerset population (all persons) has increased by 25% between 2009/10 and 2013/14.

In B&NES the hospital admission episodes with alcohol-related conditions (broad measure) rate per 100,000 of the population has been constantly greater for men than in for women between 2009/10 and 2013/14. During this period there has been a 23% increase in the rate of these admissions for men and a 30% increase for women.

Figure 1: Hospital admission episodes with alcohol-related conditions (broad measure) - Directly age standardised rate per 100,000 of the B&NES male, female and all persons populations (2009/10 to 2013/14) 5

The hospital admission episodes with alcohol-related conditions (broad measure) rate per 100,000 of the population in B&NES has been constantly lower than in the South West as a whole and England between 2009/10 and 2013/14. However, the 25% increase in the rate of these admissions in B&NES during this period is greater than the 15% increase in the South West and England.

Figure 2: Hospital admission episodes with alcohol-related conditions (broad measure) – Directly age standardised rate per 100,000 of the B&NES, South West and England populations (2009/10 to 2013/14) 6

Narrow Measure 7

This section relates to the narrow measure of hospital admission episodes with alcohol-related conditions. This narrow measure includes the primary diagnosis or any secondary diagnosis with an external cause.

The hospital admission episodes with alcohol-related conditions (narrow measure) rate per 100,000 of the B&NES population (all persons) has increased overall by 5% between 2009/10 and 2013/14, despite a 6% decrease between 2009/10 and 2011/12.

In B&NES the hospital admission episodes with alcohol-related conditions (narrow measure) rate per 100,000 of the population has been constantly greater for men than in for women between 2009/10 and 2013/14. However, during this period there has been a 2% decrease overall in the rate of these admissions for men, compared to an 8% increase overall for women.

Figure 3: Hospital admission episodes with alcohol-related conditions (narrow measure) - Directly age standardised rate per 100,000 of the B&NES male, female and all persons populations (2009/10 to 2013/14) 8

The hospital admission episodes with alcohol-related conditions (narrow measure) rate per 100,000 of the population in B&NES has been constantly lower than in the South West as a whole and England between 2009/10 and 2013/14. However, B&NES has had an overall increase of 5% in the rate of these admissions, whereas there has been a 1% decrease overall in the South West and an overall increase of only 0.02% in England. 

Figure 4: Hospital admission episodes with alcohol-related conditions (narrow measure) - Directly age standardised rate per 100,000 of the B&NES male, female and all persons populations (2009/10 to 2013/14) 9

Hospital alcohol specific and attributable admissions in Bath and North East Somerset

In 2010/11, there were 3,434 admissions due to alcohol in Bath and North East Somerset, made up of 562 wholly due to alcohol (alcohol specific) and 2,872 partially due to alcohol (alcohol attributable) 10

 Alcohol hospital admissions infographic.

Figure 5: Hospital admissions due to alcohol in Bath and North East Somerset, 2010/11, at a glance. 11

Alcohol specific hospital admissions in Bath and North East Somerset

In 2008/09 a total of 5,167 bed days were used in Bath and North East Somerset due to alcohol specific causes; the result of 904 alcohol specific admissions of 322 individuals. There were also 460 admissions with zero bed days of 294 individuals 12

Causes

The leading cause of admission for alcohol specific conditions are:

  • Mental and behavioural disorders due to use of alcohol, 62.6% of alcohol specific admissions.
  • Alcoholic liver disease (18.3%)
  • Ethanol poisoning (14.8%) 13

Types of admissions

Most alcohol specific admissions were via emergency (84.0%). 14

19.8% of individuals admitted for alcohol specific hospital admissions had repeat admissions during 2009/10. 15

In 2010 53 adults died from alcohol specific conditions in Bath and North East Somerset. 16

Gender and age

Males living in Bath and North East Somerset have lower rates of alcohol specific admissions (for conditions entirely caused by alcohol) compared to the national average, and this was statistically significantly lower than the South West rate in 2010/11. Females in Bath and North East Somerset have similar rates of alcohol specific admissions to the South West Average:

  • Males = 388.8/100,000 (South West average = 411.3/100,000)
  • Females = 217.8/100,000 (South West average = 216.4/100,000) 17

Alcohol spefific hospital admissions-line graph

Figure 6: Directly standardised rate of alcohol specific hospital admissions per 100,000 population 2006/07–2010/11 7

The 714 alcohol specific hospital admissions in 2009/10 involved 562 individuals 63% of which were males and 37% females. Of these individualsapproximately 20% were aged between 19 and 25 18

The peak age for men is those aged 40–49 (although men aged 20–24 also have relatively high levels of admission), and the peak for women is in the 15–19 age group. 19

This difference in gender is likely to come from the high rate of 15-19 year old women admitted for ethanol poisoning.

Males lose an average of 8.6 months of life from alcohol specific conditions and females lose 3.5 months (2008-10). 20

Socio-economics inequalities

People living in the most deprived areas were over four times more likely to be admitted to hospital for alcohol specific conditions than those living in the least deprived areas. Rates in the most deprived areas (two most deprived quintiles, 40%) are statistically significantly higher than in the least deprived areas (three least deprived quintiles, 60%). 21

The people and places geodemographic segmentation tool classifies people into clusters on the basis of their similarities. It is based on Office of National Statistics 2001 data and the hierarchical clusters are ranked in order of affluence using income data:

  • Regionally the sub groups with the highest rate of alcohol specific admissions by place are those classified as ‘cramped flats’, ‘hard to let’ and ‘impoverished elders’. People within these classifications are described as young adults between 16 and 24 who are working as single workers or single parents, in semi-skilled, manual and unskilled jobs. Unemployment may be high, as are incidences of long term sickness. Impoverished elders are described as pensioners, 75 and above, on low income living in social housing.
  • Regionally the following groups of people contributed the highest number of alcohol specific hospital admissions in 2008/9: Working Singles, Struggling Single Parents, Students and Young Parents 22

Alcohol attributable hospital admissions in Bath and North East Somerset

The rate of alcohol admissions attributable to alcohol in Bath and North East Somerset in 2010/11 was 1,588 per 100,000 population, this was significantly lower than the South West (1809) and the national average. (standardised for age) 23

However, admissions attributable to alcohol are increasing over time, and increasing at a faster rate than the South West average. In Bath and North East Somerset the average year on year increase in admissions is 12%, compared to 8% for the South West (since 2002/03). 24

Alcohol attributable hospital admissions-line graph

Figure 7: Directly standardised rate of alcohol attributable hospital admissions per 100,000 population 2002/03 – 2011/12 25

Whilst the data shows a 170% rise in alcohol attributable admissions between 2002/03 and 2010/11 15 , most of this increase occurred in the first year, when Bath and North East Somerset was the lowest Primary Care Trust in the South West on this measure. To get the figures into context, rates in Bath and North East Somerset are consistently lower than both regionally and nationally. 26

The main causes of alcohol attributable admissions were:

  • Hypertensive diseases (35.8%) (34.8% South West)
  • Cardiac arrhythmias (18.2%)
  • Mental and behavioural disorders due to use of alcohol (14.8%)
  • Epilepsy and status epileptics (7.3%)
  • Alcoholic liver disease (4.3%) 27

More alcohol attributable admissions were via emergency (60%) than elective (37%) or any other method of admission 28

28.4% of individuals admitted for alcohol attributable admissions had repeat admissions during 2009/10 29

Approximately 60% of alcohol attributable admissions were in people aged 60 and over. 30

Alcohol-attributable hospital admissions (does not include attendance at A&E), 2010/11:

  • Males = 1,361/100,000 (South West average = 1,280/100,000)
  • Females = 779/100,000 (South West average = 755/100,000)
  • Males increased over time 1,009/100,000 2005/6 to 1,361/100,000 2010/11
  • Women increased over time 601/100,000 2005/6 to 779/100,000 2009/10 31

The rate of alcohol attributable admissions in the most deprived area was over twice that of the least deprived area. 20 People living in the most deprived quintile (20%) are statistically significantly more likely to be admitted to hospital for alcohol attributable conditions than all the other quintiles (80%). 32