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 admissions

Alcohol-related hospital admission statistics are published annually by Public Health Scotland. The latest report, Alcohol-Related Hospital Statistics, was published in February 2023. In the financial year 2021/22, there were 35,187 alcohol-related hospital admissions (stays) in Scotland. The number of hospital admissions per 100,000 population has fallen since 2007/08, from 855 per 100,000 population to 611 per 100,000 population in 2021/22, when it was 10% lower than the rate in 2019/20 (681 per 100,000). The COVID-19 pandemic and measures put in place are likely to have contributed to the decrease since 2019/20.

• Men were 2.3 times more likely than women to be admitted to general acute hospitals for alcohol-related conditions (856 compared to 365 per 100,000 population).
• People in the most deprived areas were six times more likely to be admitted to general acute hospitals for an alcohol-related condition than those in the least deprived areas (991 compared to 153 per 100,000 population).

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 Profiles.

Alcohol-specific deaths

National Records of Scotland (NRS) publish information on the numbers of deaths which are classified as 'alcohol-specific’ annually.

A summary of the main points from the latest NRS report, 2022, are provided below:

• There were 1,276 alcohol-specific deaths registered in Scotland in 2022, an increase of 2% (31 deaths) on 2021. The rate of mortality for alcohol-specific deaths was 22.9 deaths per 100,000 people in 2022, similar to the rate of 22.3 per 100,000 people in 2021 (the increase is not statistically significant) (Table 1).
• The rate of mortality for alcohol-specific deaths fell between 2006 and 2012, from 28.5 to 18.4 deaths per 100,000 people. Since then it has generally risen and the current rate of mortality is now at a similar level to the 2010 rate (Table 1).
• Mortality rates for the 46-64 age group decreased from a high of 64.8 per 100,000 people in 2006 to 37.1 in 2019 but has since then increased over the last few years and was 46.4 per 100,000 people in 2022. Mortality rates for the 65-74 age groups are the highest since the data was first available, 52.1 per 100,000 people in 2022. For the oldest age group (age 75+) the rate of alcohol-specific mortality has generally increased since 2006, but it the rate is still about half of both of the two highest age groups (24.9). For age 25-44, the rate of mortality has generally fallen since 2006.
• Alcohol-specific deaths in females tend to be at slightly younger ages than for males. In 2022, the average age of death for females was 58.7 years and for males it was 60.0 years.
• In 2022 there were 836 (66%) male deaths and 440 (34%) female deaths from alcohol-specific causes (Table 1). Males make up around two thirds of alcohol-specific deaths in Scotland across the time series.
• Alcohol-specific deaths were 4.3 times as frequent in the most deprived areas of Scotland compared to the least deprived areas. This compares to a ratio of 1.8 times for all causes of death. This disparity in rates of alcohol-specific death has generally fallen over time but has fluctuated more in the past few years. There has been a clear and consistent trend over time showing alcohol-specific deaths are more common in more deprived areas (Table 5).
• The main underlying causes of the alcohol-specific deaths that have been registered since 2000 are alcoholic liver disease (778 deaths in 2022) and mental and behavioural disorders due to use of alcohol (397 deaths in 2022), see Table 8 of NRS report.
• NRS Tables 3 and 4 provide figures for each NHS Board area and local authority. As the figures for some areas can fluctuate markedly from year to year, the 5-year moving annual averages should indicate better any overall trend.

Mortality and morbidity 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. Examples of conditions where alcohol is wholly attributable include alcoholic liver disease and mental and behavioural disorders due to the use of alcohol. Partially attributable conditions include cancer of the lip, oral cavity and pharynx, coronary heart disease and stroke. The proportions of these conditions attributable to alcohol (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.

The impact of alcohol consumption in Scotland in terms of harms to health as well as the wider impact on individuals, families, communities and the economy is well documented. The ScotPHO report, Hospital admissions, deaths and overall burden of disease attributable to alcohol consumption in Scotland, presents revised estimates of patients admitted to hospital, deaths and the overall burden of disease attributable to alcohol consumption in Scotland by age group and sex for 2015. The key points from the main report are shown below:

Patients admitted to hospital due to alcohol consumption in 2015

• In 2015, a total of 41,161 adults aged 16 years and over were admitted to hospital at least once with a wholly or partially alcohol-attributable condition (6.4% of 644,574 total individuals admitted at least once in 2015).
• Men were twice as likely to be hospitalised with an alcohol-attributable condition in 2015 compared with women (8.8% and 4.3%, respectively)
• Of the adult patients hospitalised due to alcohol in 2015, more than one in four (27%) were admitted for an unintentional injury.

Deaths attributable to alcohol consumption in 2015

• There were an estimated 3,705 deaths attributable to alcohol consumption in 2015 among adults aged 16 years and over in Scotland. This equates to 6.5% of the total number of deaths (57,327).
• Men were almost twice as likely to die from an alcohol-attributable condition in 2015 compared with women (8.4% and 4.7%, respectively).
• More than one in four (28%) alcohol-attributable deaths were due to cancer.

Overall burden of disease attributable to alcohol consumption in 2015

• Alcohol consumption accounted for 8.0% of the burden of disease in Scotland in 2015 [104,573 out of a total 1,315,087 disease-adjusted life years (DALYs)].

Full information on the methodology and detailed tables on alcohol attributable fractions, alcohol-attributable morbidity and alcohol-attributable mortality are available in the supplementary appendix and supplementary tables of the report.

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. As of September 2013, PTI data was no longer collected and 2012/13 is the last year for which Information Services Division published annual PTI data. 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).

The Scottish Primary Care Information Resource (SPIRE) supersedes the PTI system. It is a tool that facilitates the management of information at a practice level, and extraction of primary care data at GP, practice, cluster, locality and national levels. The SPIRE tool can be used for quality improvement, local service planning and public health intelligence/research with appropriate safeguards. For further information, please refer to the SPIRE website.

Scottish Trauma Audit

The Scottish Trauma Audit Group (STAG) publishes information on trauma admissions where there was evidence that alcohol was implicated. There is evidence to suggest that alcohol remains a factor in many trauma incidents (either the alcohol was ingested by the patient or another contributor to the trauma). The downward trend for the proportion of females injured and alcohol documented has continued for major trauma only. Males with major trauma with alcohol involvement has remained similar to 2021 (25.0% to 26.2%). Alcohol was a factor in 14.2% of females suffering major trauma in 2022 (reduced from 15.1% in 2021).

See the Drugs & Alcohol section of the Audit of Trauma Management dashboard 2022, part 2. More information on the STAG inclusion criteria can be found at  www.stag.scot.nhs.uk