1
|
Myran DT, Friesen E, Talarico R, Gaudreault A, Taljaard M, Hobin E, Smith BT, Schwartz N, Giesbrecht N, Crépault JF, Tanuseputro P, Manuel DG. The association between alcohol retail access and health care visits attributable to alcohol for individuals with and without a history of alcohol-related health-care use. Addiction 2024; 119:1554-1563. [PMID: 38804474 DOI: 10.1111/add.16566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/22/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND AND AIMS Alcohol retail access is associated with alcohol use and related harms. This study measured whether this association differs for people with and without heavy and disordered patterns of alcohol use. DESIGN The study used a repeated cross-sectional analysis of health administrative databases. SETTING, PARTICIPANTS/CASES All residents of Ontario, Canada aged 10-105 years with universal health coverage (n = 10 677 604 in 2013) were included in the analysis. MEASUREMENTS Quarterly rates of emergency department (ED) and outpatient visits attributable to alcohol in 464 geographic regions between 2013 and 2019 were measured. Quarterly off-premises alcohol retail access scores were calculated (average drive to the closest seven stores) for each geographic region. Mixed-effect linear regression models adjusted for area-level socio-demographic covariates were used to examine associations between deciles of alcohol retail access and health-care visits attributable to alcohol. Stratified analyses were run for individuals with and without prior alcohol-attributable health-care use in the past 2 years. FINDINGS We included 437 707 ED visits and 505 271 outpatient visits attributable to alcohol. After adjustment, rates of ED visits were 39% higher [rate ratio (RR) = 1.39, 95% confidence interval (CI) = 1.20-1.61] and rates of outpatient visits were 49% higher (RR = 1.49, 95% CI = 1.26-1.75) in the highest versus lowest decile of alcohol access. There was a positive association between alcohol access and outpatient visits attributable to alcohol for individuals without prior health-care attributable to alcohol (RR = 1.65, 95% CI = 1.39-1.95 for the highest to lowest decile of alcohol access) but not for individuals with prior health-care attributable to alcohol (RR = 1.08, 95% CI = 0.90-1.30). There was a positive association between alcohol access and ED visits attributable to alcohol for individuals with and without prior health-care for alcohol for ED visits. CONCLUSION In Ontario, Canada, greater alcohol retail access appears to be associated with higher rates of emergency department (ED) and outpatient health-care visits attributable to alcohol. Individuals without prior health-care for alcohol may be more susceptible to greater alcohol retail access for outpatient but not ED visits attributable to alcohol.
Collapse
Affiliation(s)
- Daniel T Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Erik Friesen
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert Talarico
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Adrienne Gaudreault
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Erin Hobin
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Brendan T Smith
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Naomi Schwartz
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
| | - Norman Giesbrecht
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jean-François Crépault
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Douglas G Manuel
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
2
|
Sarraf B, Skoien R, Hartel G, O'Beirne J, Clark PJ, Collins L, Leggett B, Powell EE, Valery PC. Rising hospital admissions for alcohol-related cirrhosis and the impact of sex and comorbidity - a data linkage study. Public Health 2024; 232:178-187. [PMID: 38795666 DOI: 10.1016/j.puhe.2024.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/15/2024] [Accepted: 04/21/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES International studies have shown shifting demographic data and rising hospitalizations for alcohol-related cirrhosis (ARC), with a paucity of data from Australia. We examined hospitalizations, mortality and demographic data for people admitted with ARC over the last decade in Queensland, Australia. STUDY DESIGN Data linkage study. METHODS A retrospective analysis of adults hospitalized with ARC during 2008-2019 was performed using state-wide admissions data. International Classification of Diseases, 10th revision, codes identified admissions with the principal diagnosis of ARC based on validated algorithms. Comorbidity was assessed using the Charlson Comorbidity Index. RESULTS A total of 7152 individuals had 24,342 hospital admissions with ARC (16,388 were for ARC). There was a predominance of males (72.6%) and age ≥50 years (80.4%) at index admission. Females were admitted at a significantly younger age than men (59% of women and 43% of men were aged <60 years, P < 0.001). Comorbidities were common, with 45.1% of people having at least one comorbidity. More than half (54.6%) of the patients died over the study period (median follow-up time was 5.1 years; interquartile range 2.4-8.6). Women had significantly lower mortality, with 47.6% (95% confidence interval [CI] 45.0-50.2) probability of 5-year survival, compared with 40.1% (95% CI 38.5-41.6) in men. In multivariable analysis, this was attributable to significantly lower age and comorbidity burden in women. Significantly lower survival was seen in people with higher comorbidity burden. Overall, the number of admissions for ARC increased 2.2-fold from 869 admissions in 2008 to 1932 in 2019. CONCLUSIONS Hospital admissions for ARC have risen substantially in the last decade. Females were admitted at a younger age, with fewer comorbidities and had lower mortality compared with males. The association between greater comorbidity burden and higher mortality has important clinical implications, as comorbidity-directed interventions may reduce mortality.
Collapse
Affiliation(s)
- B Sarraf
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia; QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.
| | - R Skoien
- Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
| | - G Hartel
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia; School of Public Health, The University of Queensland, Brisbane, QLD, Australia; School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia.
| | - J O'Beirne
- Department of Gastroenterology and Hepatology, Sunshine Coast University Hospital, Sunshine Coast, QLD, Australia.
| | - P J Clark
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia; Mater Hospital Brisbane, South Brisbane, QLD, Australia; Faculty of Medicine, The University of Queensland, QLD, Australia.
| | - L Collins
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.
| | - B Leggett
- Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; Faculty of Medicine, The University of Queensland, QLD, Australia.
| | - E E Powell
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia; QIMR Berghofer Medical Research Institute, Herston, QLD, Australia; Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, QLD, Australia.
| | - P C Valery
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia; Faculty of Medicine, The University of Queensland, QLD, Australia.
| |
Collapse
|
3
|
Benny C, Hobin E, Andreacchi AT, Schwartz N, Smith BT. Socio-economic inequities in emergency department visits for wholly alcohol-attributable acute and chronic harms in Canada, 2003-2017. Drug Alcohol Rev 2024; 43:927-936. [PMID: 38388158 DOI: 10.1111/dar.13821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Individuals with low socio-economic position (SEP) experience disproportionate alcohol-attributable harm. Limited research has investigated whether these inequities are driven by alcohol-attributable conditions that are acute or chronic. The study aimed to estimate the sex-specific associations between SEP and incident wholly alcohol-attributable emergency department (ED) visits for acute and chronic harms, respectively. METHODS A cohort study was conducted using the Canadian Community Health Survey (2003-2008) linked to the National Ambulatory Care Reporting System (2002-2017) in Alberta and Ontario. SEP was measured using educational attainment. Acute and chronic ED visits were captured in the National Ambulatory Care Reporting System follow-up data. Hazard models were fit to estimate the association between SEP and acute and chronic wholly alcohol-attributable ED visits. RESULTS The analytical sample included 88,865 respondents. In men and women, individuals with lower SEP had increased hazard of acute ED visits (women hazard ratio [HR] 1.75, 95% confidence interval [CI] 1.07-2.87; men HR 3.47, 95% CI 2.29-5.25) and chronic ED visits (women HR 2.24, 95% CI 1.04-4.80; men HR 5.02, 95% CI 2.88-8.75). Acute and chronic wholly alcohol-attributable ED visit rates were higher in men than women. DISCUSSION AND CONCLUSIONS The findings indicated lower SEP was associated with greater harms for both acute and chronic wholly alcohol-attributable ED visits when compared to their higher SEP counterparts. We conclude that gradients in SEP are associated with acute and chronic harms. These results highlight a need for equitable interventions that reduce the absolute burden of inequities in both acute and chronic wholly alcohol-attributable ED visits.
Collapse
Affiliation(s)
| | - Erin Hobin
- Public Heath Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Alessandra T Andreacchi
- Public Heath Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Brendan T Smith
- Public Heath Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| |
Collapse
|
4
|
Harrison LD, Dumicho AY, Eddeen AB, Tanuseputro P, Kendall CE, Fiedorowicz JG, Rosic T, Fernando SM, McNaughton CD, Corace K, Kurdyak P, Beckerleg W, Webber C, Gardner W, Sood M, Myran DT. Mortality in adolescents and young adults following a first presentation to the emergency department for alcohol. Acad Emerg Med 2024; 31:220-229. [PMID: 38097531 DOI: 10.1111/acem.14843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/09/2023] [Accepted: 11/26/2023] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND METHODS We conducted a population-based, retrospective cohort study of first-time emergency department (ED) visits in adolescents and young adults (AYA) due to alcohol and compared mortality to AYA with nonalcohol ED visits between 2009 and 2015 using standardized all-cause mortality ratios (age, sex, income, and rurality). We described the cause of death for AYA and examined the association between clinical factors and mortality rates in the alcohol cohort using proportional hazard models. RESULTS A total of 71,776 AYA had a first-time ED visit due to alcohol (56.1% male, mean age 20.7 years) between 2009 and 2015, representing 3.3% of the 2,166,838 AYA with an ED visit in this time period. At 1 year, there were 2396 deaths, 248 (10.3%) following an ED visit related to alcohol. First-time alcohol ED visits were associated with a threefold higher risk in mortality at 1 year (0.35% vs. 0.10%, adjusted hazard ratio [aHR] 3.07, 95% confidence interval [CI] 2.69-3.51). Mortality was associated with age 25-29 years (aHR 3.88, 95% CI 2.56-5.86), being male (aHR 1.98, 95% CI 1.49-2.62), having a history of mental health or substance use (aHR 3.22, 95% CI 1.64-6.32), cause of visit being withdrawal/dependence (aHR 2.81, 95% CI 1.96-4.02), and having recurrent ED visits (aHR 1.97, 95% CI 1.27-3.05). Trauma (42.7%), followed by poisonings from drugs other than opioids (38.3%), and alcohol (28.6%) were the most common contributing causes of death. CONCLUSION Incident ED visits due to alcohol in AYA are associated with a high risk of 1-year mortality, especially in young adults, those with concurrent mental health or substance use disorders, and those with a more severe initial presentation. These findings may help inform the need and urgency for follow-up care in this population.
Collapse
Affiliation(s)
- Lyndsay D Harrison
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Asnake Y Dumicho
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Anan Bader Eddeen
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Primary Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Claire E Kendall
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ontario, Canada
- Lamont Primary Health Care Research Centre, Riverside Campus Family Health Team, Ottawa, Ontario, Canada
| | - Jess G Fiedorowicz
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Tea Rosic
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Shannon M Fernando
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Critical Care, Lakeridge Health Corporation, Oshawa, Ontario, Canada
| | - Candace D McNaughton
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- ICES Central, Toronto, Ontario, Canada
| | - Kim Corace
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Kurdyak
- ICES Central, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Weiwei Beckerleg
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Colleen Webber
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - William Gardner
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- CHEO Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Manish Sood
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel Thomas Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ontario, Canada
| |
Collapse
|
5
|
Fitzgerald N, Egan M, O'Donnell R, Nicholls J, Mahon L, de Vocht F, McQuire C, Angus C, Purves R, Henney M, Mohan A, Maani N, Shortt N, Bauld L. Public health engagement in alcohol licensing in England and Scotland: the ExILEnS mixed-method, natural experiment evaluation. PUBLIC HEALTH RESEARCH 2024:1-76. [PMID: 38345369 DOI: 10.3310/fsrt4135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
Background International systematic reviews suggest an association between alcohol availability and increased alcohol-related harms. Alcohol availability is regulated through separate locally administered licensing systems in England and Scotland, in which local public health teams have a statutory role. The system in Scotland includes a public health objective for licensing. Public health teams engage to varying degrees in licensing matters but no previous study has sought to objectively characterise and measure their activity, examine their effectiveness, or compare practices between Scotland and England. Aim To critically assess the impact and mechanisms of impact of public health team engagement in alcohol premises licensing on alcohol-related harms in England and Scotland. Methods We recruited 39 diverse public health teams in England (n = 27) and Scotland (n = 12). Public health teams more active in licensing were recruited first and then matched to lower-activity public health teams. Using structured interviews (n = 66), documentation analysis, and expert consultation, we developed and applied the Public Health Engagement In Alcohol Licensing (PHIAL) measure to quantify six-monthly activity levels from 2012 to 2019. Time series of PHIAL scores, and health and crime outcomes for each area, were analysed using multivariable negative binomial mixed-effects models to assess correlations between outcome and exposure, with 18-month average PHIAL score as the primary exposure metric. In-depth interviews (n = 53) and a workshop (n = 10) explored public health team approaches and potential mechanisms of impact of alcohol availability interventions with public health team members and licensing stakeholders (local authority licensing officers, managers and lawyers/clerks, police staff with a licensing remit, local elected representatives). Findings Nineteen public health team activity types were assessed in six categories: (1) staffing; (2) reviewing and (3) responding to licence applications; (4) data usage; (5) influencing licensing stakeholders/policy; and (6) public involvement. Usage and intensity of activities and overall approaches varied within and between areas over time, including between Scotland and England. The latter variation could be explained by legal, structural and philosophical differences, including Scotland's public health objective. This objective was felt to legitimise public health considerations and the use of public health data within licensing. Quantitative analysis showed no clear evidence of association between level of public health team activity and the health or crime outcomes examined, using the primary exposure or other metrics (neither change in, nor cumulative, PHIAL scores). Qualitative data suggested that public health team input was valued by many licensing stakeholders, and that alcohol availability may lead to harms by affecting the accessibility, visibility and norms of alcohol consumption, but that the licensing systems have limited power to act in the interests of public health. Conclusions This study provides no evidence that public health team engagement in local licensing matters was associated with measurable downstream reductions in crime or health harms, in the short term, or over a 7-year follow-up period. The extensive qualitative data suggest that public health team engagement is valued and appears to be slowly reorienting the licensing system to better address health (and other) harms, especially in Scotland, but this will take time. A rise in home drinking, alcohol deliveries, and the inherent inability of the licensing system to reduce - or in the case of online sales, to contain - availability, may explain the null findings and will continue to limit the potential of these licensing systems to address alcohol-related harms. Future work Further analysis could consider the relative success of different public health team approaches in terms of changing alcohol availability and retailing. A key gap relates to the nature and impact of online availability on alcohol consumption, harms and inequalities, alongside development and study of relevant policy options. A national approach to licensing data and oversight would greatly facilitate future studies and public health input to licensing. Limitations Our interview data and therefore PHIAL scores may be limited by recall bias where documentary evidence of public health activity was not available, and by possible variability in grading of such activity, though steps were taken to minimise both. The analyses would have benefited from additional data on licensing policies and environmental changes that might have affected availability or harms in the study areas. Study registration The study was registered with the Research Registry (researchregistry6162) on 26 October 2020. The study protocol was published in BMC Medical Research Methodology on 6 November 2018. Funding This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 15/129/11.
Collapse
Affiliation(s)
- Niamh Fitzgerald
- Institute for Social Marketing and Health, University of Stirling, Scotland, UK
- SPECTRUM Consortium, UK
| | - Matt Egan
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- NIHR School for Public Health Research, Tyne and Wear, UK
| | - Rachel O'Donnell
- Institute for Social Marketing and Health, University of Stirling, Scotland, UK
| | - James Nicholls
- Faculty of Health Sciences and Sport, University of Stirling, Scotland, UK
| | - Laura Mahon
- Alcohol Focus Scotland, Glasgow, Scotland, UK
| | - Frank de Vocht
- NIHR School for Public Health Research, Tyne and Wear, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West, Bristol, UK
| | - Cheryl McQuire
- NIHR School for Public Health Research, Tyne and Wear, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Colin Angus
- SPECTRUM Consortium, UK
- School of Health and Related Research, University of Sheffield, UK
| | - Richard Purves
- Institute for Social Marketing and Health, University of Stirling, Scotland, UK
| | - Madeleine Henney
- School of Health and Related Research, University of Sheffield, UK
| | - Andrea Mohan
- School of Health Sciences, University of Dundee, Scotland, UK
| | - Nason Maani
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Niamh Shortt
- SPECTRUM Consortium, UK
- School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - Linda Bauld
- SPECTRUM Consortium, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
6
|
Hunter S, Farmer G, Benny C, Smith BT, Pabayo R. The association between social fragmentation and deaths attributable to alcohol, drug use, and suicide: Longitudinal evidence from a population-based sample of Canadian adults. Prev Med 2023; 175:107688. [PMID: 37652109 DOI: 10.1016/j.ypmed.2023.107688] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/25/2023] [Accepted: 08/27/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Social fragmentation has been theorized and empirically associated with suicide in prior research. However, less is known about whether social fragmentation is associated with deaths attributed to alcohol use or drug use. This research examined the association between social fragmentation and risk for deaths attributable to alcohol use, drug use, and suicide (collectively known as deaths of despair) among Canadian adults. METHODS A weighted sample representing 15,324,645 Canadians within 288 census divisions between 2006 and 2019 was used. Mortality data from the Canadian Vital Statistics Database (alcoholic liver disease, drug use, and suicide) was linked with census division socioeconomic data from the 2006 Canadian census using the Canadian Census Health and Environment Cohorts. Social fragmentation at the census division was created based on the Congdon Index. Cox-proportional hazard regression with survey weights and the sandwich estimator were used to account for clustering of individuals (level-1) nested within census divisions (level-2). RESULTS After adjusting for individual and census division confounders, social fragmentation was positively associated with all-cause mortality (HR = 1.04; 95% CI: 1.02, 1.07), suicide (HR = 1.09; 95%CI: 1.01, 1.18), drug overdose related mortality (HR = 1.13; 95%CI: 1.03, 1.24), and deaths of despair (HR = 1.10; 95% CI: 1.04, 1.16), and not significantly associated with alcohol related liver disease (HR = 1.06; 95% CI: 0.91, 1.23). CONCLUSION Social fragmentation is associated with an increased hazard of deaths of despair among Canadian adults. Efforts to improve social cohesion in areas that are highly socially fragmented need to be evaluated.
Collapse
Affiliation(s)
- Stephen Hunter
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, AB T6G 1C9, Canada.
| | - Gregory Farmer
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, AB T6G 1C9, Canada; Provincial Population and Public Health, Alberta Health Services, 10030 107 St NW, Edmonton, AB T5J 3E4, Canada
| | - Claire Benny
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON M5G 1V2, Canada
| | - Brendan T Smith
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON M5G 1V2, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, Room 500, Toronto, ON M5T 3M7, Canada
| | - Roman Pabayo
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, AB T6G 1C9, Canada
| |
Collapse
|
7
|
van Roozendaal H, Verhulst S, Glazemakers I, De Meulder F, Vander Auwera A, Bael A, Van Damme E, Vlemincx I, De Dooy J, van der Lely N, Van Hal G. Characteristics of Adolescents Admitted with Acute Alcohol Intoxication: A Retrospective Multicentre Study in Antwerp, Belgium, in the Period 2015-2021. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1378. [PMID: 37628377 PMCID: PMC10453587 DOI: 10.3390/children10081378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023]
Abstract
Binge drinking among adolescents is common in Belgium, posing a risk of serious health consequences. Until today, only estimations of the prevalence of acute alcohol intoxication (AAI) in adolescents have been made. Research into potential risk factors has not yet been conducted in Belgium. Therefore, this study aims to gain more insight into the prevalence, medical characteristics and potential risk factors of AAI among adolescents. A retrospective multicentre chart study was performed on adolescents aged 10-17 years with AAI in Antwerp, Belgium (2015-2021). Patient's demographics, medical characteristics and information regarding the context of the AAI were collected from medical charts. Over the study period, a total of 1016 patients were admitted with AAI in Antwerp, having a median age of 16.6 years old, a median blood alcohol concentration of 1.95 g/L and combined drug use in 10% of cases. These findings did not significantly change over the study period. Multiple linear regression analysis indicated that after correcting for covariates, higher age, no combined drug use and decreased consciousness at admission were associated with more severe AAI cases (higher blood alcohol concentration). This study shows that AAI is prevalent among Belgian adolescents, and better targeted preventive measures and policies are needed. Our findings could be taken into account when developing preventive measures. However, data addressing the demographics and context of AAI were mostly missing. Therefore, prospective research is required to further investigate potential risk factors associated with AAI.
Collapse
Affiliation(s)
- Hanna van Roozendaal
- Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium; (I.G.); (A.B.); (J.D.D.); (N.v.d.L.); (G.V.H.)
| | - Stijn Verhulst
- Department of Paediatrics, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Inge Glazemakers
- Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium; (I.G.); (A.B.); (J.D.D.); (N.v.d.L.); (G.V.H.)
- University Centre for Child and Adolescent Psychiatry (ZNA-UKJA), 2020 Antwerp, Belgium
| | - Frederic De Meulder
- Department of Paediatrics, GasthuisZusters Antwerpen (GZA), 2018 Antwerp, Belgium; (F.D.M.); (A.V.A.)
| | - Ann Vander Auwera
- Department of Paediatrics, GasthuisZusters Antwerpen (GZA), 2018 Antwerp, Belgium; (F.D.M.); (A.V.A.)
| | - Anna Bael
- Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium; (I.G.); (A.B.); (J.D.D.); (N.v.d.L.); (G.V.H.)
- Department of Paediatrics, Hospital Network Antwerp (ZNA), 2020 Antwerp, Belgium;
| | - Emmi Van Damme
- Department of Paediatrics, Hospital Network Antwerp (ZNA), 2020 Antwerp, Belgium;
| | - Ilse Vlemincx
- Department of Paediatrics, General Hospital (AZ) Monica, 2100 Antwerp, Belgium;
| | - Jozef De Dooy
- Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium; (I.G.); (A.B.); (J.D.D.); (N.v.d.L.); (G.V.H.)
- Department of Paediatrics, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Nico van der Lely
- Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium; (I.G.); (A.B.); (J.D.D.); (N.v.d.L.); (G.V.H.)
- Department of Paediatrics, Reinier de Graaf Hospital, 2625 AD Delft, The Netherlands
| | - Guido Van Hal
- Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium; (I.G.); (A.B.); (J.D.D.); (N.v.d.L.); (G.V.H.)
| |
Collapse
|
8
|
Ogunlayi F, Coleman PC, Fat LN, Mindell JS, Oyebode O. Trends in socioeconomic inequalities in behavioural non-communicable disease risk factors: analysis of repeated cross-sectional health surveys in England between 2003 and 2019. BMC Public Health 2023; 23:1442. [PMID: 37501159 PMCID: PMC10375601 DOI: 10.1186/s12889-023-16275-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 07/09/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Previous studies have shown that those in lower socioeconomic positions (SEPs) generally have higher levels of behavioural non-communicable disease (NCD) risk factors. However, there are limited studies examining recent trends in inequalities. This study examined trends in socioeconomic inequalities in NCD behavioural risk factors and their co-occurrence in England from 2003-19. METHODS This time-trend analysis of repeated cross-sectional data from the Health Survey for England examined the relative index of inequalities (RII) and slope index of inequalities (SII) in four NCD behavioural risk factors: smoking; drinking above recommended limits; insufficient fruit and vegetables consumption; and physical inactivity. FINDINGS Prevalence of risk factors has reduced over time, however, this has not been consistent across SEPs. Absolute and relative inequalities increased for physical inactivity; relative inequalities also increased for smoking; for insufficient fruit and vegetable consumption, the trends in inequalities depended on SEPs measure. Those in lower SEPs experienced persistent socioeconomic inequalities and clustering of behavioural risk factors. In contrast, those in higher SEPs had higher prevalence of excessive alcohol consumption; this inequality widened over the study period. INTERPRETATION Inequalities in smoking and physical inactivity are persisting or widening. The pattern of higher drinking in higher SEPs obscure the fact that the greatest burden of alcohol-related harm falls on lower SEPs. Policy attention is required to tackle increasing inequalities in smoking prevalence, low fruit and vegetable consumption and physical inactivity, and to reduce alcohol harm.
Collapse
Affiliation(s)
- Fatai Ogunlayi
- University of Warwick, Warwick Medical School, Coventry, CV4 7AL, UK.
| | - Paul C Coleman
- University of Warwick, Warwick Medical School, Coventry, CV4 7AL, UK
- Centre for Food Policy, City University of London, London, EC1V 0HB, UK
| | - Linda Ng Fat
- Health and Social Surveys Group, Research Department of Epidemiology and Public Health, University College London (UCL), 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Jennifer S Mindell
- Health and Social Surveys Group, Research Department of Epidemiology and Public Health, University College London (UCL), 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Oyinlola Oyebode
- University of Warwick, Warwick Medical School, Coventry, CV4 7AL, UK
- Wolfson Institute of Population Health, Queen Mary University of London, London, EC1M 6BQ, UK
| |
Collapse
|
9
|
Wolfe M, Menon A, Oto M, Fullerton NE, Leach JP. Alcohol and the central nervous system. Pract Neurol 2023:pn-2023-003817. [PMID: 37328277 DOI: 10.1136/pn-2023-003817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 06/18/2023]
Abstract
Ethanol use is common to most cultures but with varying doses and to varying extents. While research has focused on the effects on the liver, alcohol exerts a range of actions on the function and structure of the nervous system. In the central nervous system (CNS) it can provoke or exacerbate neurological and psychiatric disease; its effects on the peripheral nervous system are not included in this review. Sustained alcohol intake can predispose to acute neurochemical changes which, with continued ingestion and incomplete treatment, can lead to chronic structural changes in the CNS: these include generalised cortical and cerebellar atrophy, amnesic syndromes such as Korsakoff's syndrome, and specific white matter disorders such as central pontine myelinolysis and Marchiafava-Bignami syndrome. Alcohol in pregnancy commonly and significantly affects fetal health, though this receives less medical and political attention than other causes of fetal harm. This review looks at the range of disorders that can follow acute or chronic alcohol use, and how these should be managed, and we provide a practical overview on how neurologists might diagnose and manage alcohol addiction.
Collapse
Affiliation(s)
- Maytal Wolfe
- University of Glasgow, Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK
| | - Arun Menon
- University of Glasgow, Glasgow, UK
- Gartnavel Royal Hospital, Glasgow, UK
| | - Maria Oto
- Queen Elizabeth University Hospital, Glasgow, UK
| | - Natasha E Fullerton
- University of Glasgow, Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK
| | | |
Collapse
|
10
|
Niu X, Zhu L, Xu Y, Zhang M, Hao Y, Ma L, Li Y, Xing H. Global prevalence, incidence, and outcomes of alcohol related liver diseases: a systematic review and meta-analysis. BMC Public Health 2023; 23:859. [PMID: 37170239 PMCID: PMC10173666 DOI: 10.1186/s12889-023-15749-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/25/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Alcohol related liver disease (ARLD) is one of the major chronic liver diseases worldwide. This review aimed to describe the global prevalence, incidence, and outcomes of ARLD. METHODS Medline, Embase, The Cochrane Library, and China National Knowledge Infrastructure (CNKI) were searched from inception to May 31, 2022. The language was restricted to English or Chinese. According to the criteria, articles describing the basic characteristics of the population were selected. Two reviewers extracted the data independently. RESULTS A total of 372 studies were identified: 353 were used for prevalence analysis, 7 were used for incidence analysis, and 114 were used to for outcome analysis. The prevalence of ARLD worldwide was 4.8%. The prevalence in males was 2.9%, which was higher than female (0.5%). Among the ethnic groups, the percentage was highest in Caucasians (68.9%). Alcoholic liver cirrhosis comprised the highest proportion in the disease spectrum of ARLD at 32.9%. The prevalence of ascites in ARLD population was highest (25.1%). The ARLD population who drinking for > 20 years accounted for 54.8%, and the average daily alcohol intake was 146.6 g/d. About 59.5% of ARLD patients were current or former smokers, and 18.7% were complicated with hepatitis virus infection. The incidence was 0.208/1000 person-years. The overall mortality was 23.9%, and the liver-related mortality was 21.6%. CONCLUSION The global prevalence of ARLD was 4.8% and was affected by sex, region, drinking years, and other factors. Therefore, removing the factors causing a high disease prevalence is an urgent requisite. TRIAL REGISTRATION PROSPERO Nr: CRD42021286192.
Collapse
Affiliation(s)
- Xuanxuan Niu
- Center of Liver Diseases Division 3, Beijing Ditan Hospital, Capital Medical University, 8 Jingshundong Street, Chaoyang District, Beijing, 100015, China
| | - Lin Zhu
- Center of Liver Diseases Division 3, Beijing Ditan Hospital, Capital Medical University, 8 Jingshundong Street, Chaoyang District, Beijing, 100015, China
| | - Yifan Xu
- Center of Liver Diseases Division 3, Beijing Ditan Hospital, Capital Medical University, 8 Jingshundong Street, Chaoyang District, Beijing, 100015, China
| | - Menghan Zhang
- Center of Liver Diseases Division 3, Beijing Ditan Hospital, Capital Medical University, 8 Jingshundong Street, Chaoyang District, Beijing, 100015, China
| | - Yanxu Hao
- Center of Liver Diseases Division 3, Beijing Ditan Hospital, Capital Medical University, 8 Jingshundong Street, Chaoyang District, Beijing, 100015, China
| | - Lei Ma
- Center of Liver Diseases Division 3, Beijing Ditan Hospital, Capital Medical University, 8 Jingshundong Street, Chaoyang District, Beijing, 100015, China
| | - Yan Li
- Center of Liver Diseases Division 3, Beijing Ditan Hospital, Capital Medical University, 8 Jingshundong Street, Chaoyang District, Beijing, 100015, China
| | - Huichun Xing
- Center of Liver Diseases Division 3, Beijing Ditan Hospital, Capital Medical University, 8 Jingshundong Street, Chaoyang District, Beijing, 100015, China.
- Peking University Ditan Teaching Hospital, Beijing, 100015, China.
| |
Collapse
|
11
|
Yuen WS, Peacock A, Man N, Callinan S, Slade T, Farrell M, Mattick R, Livingston M. Age, period and cohort effects on alcohol-related risky behaviours in Australia from 2001 to 2016. Addiction 2023; 118:438-448. [PMID: 36206499 PMCID: PMC10952598 DOI: 10.1111/add.16061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/20/2022] [Indexed: 02/07/2023]
Abstract
AIMS The aim of this study is to examine age, period and birth cohort trends in the prevalence of any alcohol-related risky behaviour and to compare these trends between men and women. DESIGN AND SETTING We used an age-period-cohort analysis of repeated cross-sectional survey data from the Australian National Drug Strategy Household Survey from 2001 to 2016. PARTICIPANTS Participants were 121 281 people aged 14-80 years who reported consuming alcohol in the past 12 months. MEASUREMENTS Any risky behaviour undertaken while under the influence of alcohol in the past 12 months (e.g. operating a motor vehicle) was measured: male or female. FINDINGS Controlling for age and cohort, cubic spline models showed that any alcohol-related risky behaviour declined with time among participants who consumed alcohol [2016 versus 2007 rate ratio (RR) = 0.80, 95% confidence interval (CI) = 0.76-0.84]. Risky behaviour peaked in the 1954 birth cohort (1954 versus 1971 RR = 1.42, 95% CI = 1.30-1.55) and then steadily declined with more recent birth cohorts (2002 versus 1971 RR = 0.32, 95% CI = 0.27-0.39). Risky behaviour peaked at age 21 years, followed by steady decline and stabilization at approximately age 70 years. Males were overall twice as likely as females to report alcohol-related risky behaviour (RR = 2.10, 95% CI = 1.84-2.39), but this effect was smaller in cohorts born after 1980 [1980 prevalence rate ratios (PRR) = 2.09, 95% CI = 1.81-2.43; 2002 PRR = 1.31, 95% CI = 1.03-1.68]. CONCLUSIONS Alcohol-related risky behaviour in Australia has declined generally since 2001, with rates for recent cohorts having the sharpest decline. Risky behaviour remains most prevalent in young adults, and the male-female gap in risky behaviour is closing for more recent birth cohorts. These trends are consistent with alcohol consumption trends observed in Australia and world-wide.
Collapse
Affiliation(s)
- Wing See Yuen
- National Drug and Alcohol Research CentreUNSW SydneyKensingtonAustralia
| | - Amy Peacock
- National Drug and Alcohol Research CentreUNSW SydneyKensingtonAustralia
- School of Psychological SciencesUniversity of TasmaniaHobartAustralia
| | - Nicola Man
- National Drug and Alcohol Research CentreUNSW SydneyKensingtonAustralia
| | - Sarah Callinan
- Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneAustralia
| | - Tim Slade
- The Matilda CentreThe University of SydneyCamperdownAustralia
| | - Michael Farrell
- National Drug and Alcohol Research CentreUNSW SydneyKensingtonAustralia
| | - Richard Mattick
- National Drug and Alcohol Research CentreUNSW SydneyKensingtonAustralia
| | - Michael Livingston
- Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneAustralia
- National Drug Research Institute and enAble Institute, Faculty of Health SciencesCurtin UniversityPerthAustralia
- Centre for Clinical NeuroscienceKarolinska InstituteSolnaSweden
| |
Collapse
|
12
|
Smith BT, Schoer N, Sherk A, Thielman J, McKnight A, Hobin E. Trends in alcohol-attributable hospitalisations and emergency department visits by age, sex, drinking group and health condition in Ontario, Canada. Drug Alcohol Rev 2023; 42:926-937. [PMID: 36843065 DOI: 10.1111/dar.13629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/20/2022] [Accepted: 01/26/2023] [Indexed: 02/28/2023]
Abstract
INTRODUCTION Alcohol-attributable harms are increasing in Canada. We described trends in alcohol-attributable hospitalisations and emergency department (ED) visits by age, sex, drinking group, attribution and health condition. METHODS Hospitalisation and ED visits for partially or wholly alcohol-attributable health conditions by age and sex were obtained from population-based health administrative data for individuals aged 15+ in Ontario, Canada. Population-level alcohol exposure was estimated using per capita alcohol sales and alcohol use data. We estimated the number and rate of alcohol-attributable hospitalisations (2008-2018) and ED visits (2008-2019) using the International Model of Alcohol Harms and Policies (InterMAHP). RESULTS Over the study period, the modelled rates of alcohol-attributable health-care encounters were higher in males, but increased faster in females. Specifically, rates of alcohol-attributable hospitalisations and ED visits increased by 300% (19-76 per 100,000) and 37% (774-1,064 per 100,000) in females, compared to 20% (322-386 per 100,000) and 2% (2563-2626 per 100,000) in males, respectively. Alcohol-attributable ED visit rates were highest among individuals aged 15-34, however, increased faster among individuals aged 65+ (females: 266%; males: 44%) than 15-34 years (females:+17%; males: -16%). High-volume drinkers had the highest rates of alcohol-attributable health-care encounters; yet, low-/medium-volume drinkers contributed substantial hospitalisations (11%) and ED visits (36%), with increasing rates of ED visits in females drinking low/medium volumes. DISCUSSION AND CONCLUSIONS Alcohol-attributable health-care encounters increased overall, and faster among females, adults aged 65+ and low-/medium-volume drinkers. Monitoring trends across subpopulations is imperative to inform equitable interventions to mitigate alcohol-attributable harms.
Collapse
Affiliation(s)
- Brendan T Smith
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Nicole Schoer
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Canada
| | - Adam Sherk
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility, Victoria, Canada
| | - Justin Thielman
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Canada
| | - Anthony McKnight
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Erin Hobin
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility, Victoria, Canada
| |
Collapse
|
13
|
Ventura-Cots M, Bataller R, Lazarus JV, Benach J, Pericàs JM. Applying an equity lens to liver health and research in Europe. J Hepatol 2022; 77:1699-1710. [PMID: 35985542 DOI: 10.1016/j.jhep.2022.07.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 12/04/2022]
Abstract
Liver disease is a major cause of premature death and disability in Europe. However, morbidity and mortality are not equally distributed in the population. In spite of this, there are few studies addressing the issue of health inequalities in Europe. In this Public Health Corner article, we compare the research conducted on health inequalities in Europe to other settings and highlight the main differences based upon an extensive review of the literature. We report that only 10.2% of studies were led by European institutions or conducted in European populations and that certain topics such as alcohol-related liver disease are largely overlooked. In addition, we discuss the relevance of including a health equity lens when conducting clinical, epidemiological and health systems' research in liver disease and set out the basic requirements to tackle health inequalities in liver disease in Europe.
Collapse
Affiliation(s)
- Meritxell Ventura-Cots
- Liver Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Campus Hospitalari, Barcelona, Spain; Centro de Investigación Biomédica en Red de enfermedades digestivas y hepáticas (CIBERehd), Madrid, Spain
| | - Ramon Bataller
- Center for Liver Diseases, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; CUNY Graduate School of Public Health and Health Policy, NY, New York, USA
| | - Joan Benach
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain; Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (UPF-BSM), Barcelona, Spain; Ecological Humanities Research Group (GHECO), Universidad Autónoma de Madrid, Madrid, Spain
| | - Juan M Pericàs
- Liver Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Campus Hospitalari, Barcelona, Spain; Centro de Investigación Biomédica en Red de enfermedades digestivas y hepáticas (CIBERehd), Madrid, Spain; Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (UPF-BSM), Barcelona, Spain.
| |
Collapse
|
14
|
Horrell J, Callaghan L, Dhanda A. Alcohol misuse in patients with alcohol-related liver disease: How can we do better? A narrative review of the literature. Alcohol Clin Exp Res 2022; 46:1364-1370. [PMID: 35766348 PMCID: PMC9543176 DOI: 10.1111/acer.14895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ongoing alcohol use is strongly associated with progressive liver damage and higher mortality in patients with alcohol-related liver disease (ArLD). Reduction in alcohol use is therefore the cornerstone of treatment to improve the long-term outcome of these patients. However, a large proportion of patients continue to use alcohol and do not access or engage with alcohol treatment services after a diagnosis of ArLD. We reviewed the literature on factors associated with ongoing alcohol consumption among patients with ArLD to identify barriers or facilitators to their accessing alcohol treatment. METHODS A search of MEDLINE and EMBASE was conducted using search strategies relating to ArLD and the psychosocial factors hypothesized to influence alcohol reduction and/or abstinence. RESULTS There were few relevant studies pertinent to this population group. Several studies reported a high prevalence of mental health diagnoses associated with the severity of alcohol dependence. Social and environmental factors were shown to be important determinants of alcohol use. Common themes perceived as barriers to treatment from qualitative interviews with ArLD patients across studies included poor communication between the clinical team and patient, lack of symptoms recognized by patients themselves, and perceived loss of control over their condition. CONCLUSIONS We recommend that future clinical studies of patient cohorts with ArLD include detailed psychosocial assessments to capture information on mental health and social factors. Qualitative studies are required to explore the patient journey pre and post hospital admission, which should focus on identifying facilitators and barriers to accessing treatment. Well-designed, controlled studies are needed to identify patient, social, and environmental factors associated with relapse to alcohol use after a diagnosis of ArLD. These data will enable us to adapt our support for patients to enhance engagement with services and improve long-term outcomes.
Collapse
Affiliation(s)
- Jane Horrell
- Peninsula Medical School, Faculty of HealthUniversity of PlymouthPlymouthUK
| | - Lynne Callaghan
- Peninsula Medical School, Faculty of HealthUniversity of PlymouthPlymouthUK
| | - Ashwin Dhanda
- Peninsula Medical School, Faculty of HealthUniversity of PlymouthPlymouthUK,South West Liver UnitUniversity Hospitals Plymouth NHS TrustPlymouthUK
| |
Collapse
|
15
|
Myran D, Hsu A, Kunkel E, Rhodes E, Imsirovic H, Tanuseputro P. Socioeconomic and Geographic Disparities in Emergency Department Visits due to Alcohol in Ontario: A Retrospective Population-level Study from 2003 to 2017. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:534-543. [PMID: 34254563 PMCID: PMC9234901 DOI: 10.1177/07067437211027321] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE While the overall health system burden of alcohol is large and increasing in Canada, little is known about how this burden differs by sociodemographic factors. The objectives of this study were to assess sociodemographic patterns and temporal trends in emergency department (ED) visits due to alcohol to identify emerging and at-risk subgroups. METHODS We conducted a retrospective population-level cohort study of all individuals aged 10 to 105 living in Ontario, Canada. We identified ED visits due to alcohol between 2003 and 2017 using defined International Classification of Diseases, 10th edition, codes from a pre-existing indicator. We calculated annual age- and sex-standardized, and age- and sex-specific rates of ED visits and compared overall patterns and changes over time between urban and rural settings and income quintiles. RESULTS There were 829,662 ED visits due to alcohol over 15 years. Rates of ED visits due to alcohol were greater for individual living in the lowest- compared to the highest-income quintile neighbourhoods, and disparities (rate ratio lowest to highest quintile) increased with age from 1.22 (95% CI, 1.19 to 1.25) in 15- to 18-year-olds to 4.17 (95% CI, 4.07 to 4.28) in 55- to 59-year-olds. Rates of ED visits due to alcohol were significantly greater in rural settings (56.0 per 10,000 individuals, 95% CI, 55.7 to 56.4) compared to urban settings (44.8 per 10,000 individuals, 95% CI, 44.7 to 44.9), particularly for young adults. Increases in rates of visits between 2003 and 2017 were greater in rural versus urban settings (82 vs. 68% increase in age- and sex-standardized rates) and varied across sociodemographic subgroups with the largest annual increases in rates of visits in young (15 to 29) low-income women (6.9%, 95%CI, 6.7 to 7.3) and the smallest increase in older (45 to 59) high-income men (2.7, 95%CI, 2.4 to 3.0). CONCLUSION Alcohol harms display unique patterns with the highest burden in rural and lower-income populations. Rural-urban and income-based disparities differ by age and sex and have increased over time, which offers an imperative and opportunity for further interventions by clinicians and policy makers.
Collapse
Affiliation(s)
- Daniel Myran
- 10055The Ottawa Hospital Research Institute, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Amy Hsu
- 10055The Ottawa Hospital Research Institute, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | | | - Emily Rhodes
- 10055The Ottawa Hospital Research Institute, Ontario, Canada
| | | | - Peter Tanuseputro
- Department of Family Medicine, University of Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ontario, Canada
| |
Collapse
|
16
|
Armstrong PR, Ring É, MacNicholas R. A decade of rising alcoholic liver disease hospital admissions and deaths in Irish hospitals, 2007-2016: a retrospective cross-sectional analysis. Eur J Gastroenterol Hepatol 2022; 34:671-677. [PMID: 34985049 DOI: 10.1097/meg.0000000000002339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Alcoholic liver disease (ALD) is a major cause of both liver cirrhosis and hepatocellular carcinoma (HCC) in Ireland. AIMS The aim of the study was to identify the epidemiological profile, temporal trends, development of complications and mortality arising from inpatient care episodes linked to ALD in Ireland from 2007 to 2016. METHODS This was a national retrospective study that analysed data on patient discharges from hospitals across Ireland. The Hospital Inpatient Enquiry System was used to gather this data. The main outcome measures were the number of hospital discharges for patients with ALD or HCC, also expressed per 100 000 population, the mortality rate associated with ALD and the prevalence of complications associated with ALD. RESULTS A total of 33 794 hospital discharges were examined. There was a 38% increase in hospital discharges and 300% increase in HCC coding for patients with ALD between 2006 and 2016. There were 73 hospital discharges with ALD per 100 000 population in 2016. That year, 40 482 bed days were required for inpatient management equating to 120 beds per day. Deaths from ALD rose by 29% over the 10-year period. Cirrhosis was diagnosed in 57% and 24% had ascites. Mortality was 9.8% rising to 16% with variceal bleeding and 42% with acute kidney injury. Only 31% were under the care of a gastroenterologist or hepatologist. CONCLUSION Ireland is seeing a rise in ALD-related hospital admissions and deaths, including HCC which increased three-fold. ALD is a preventable disease, and public health interventions are of proven benefit and required to reverse this trend.
Collapse
Affiliation(s)
- Paul R Armstrong
- Department of Hepatology, The National Liver Transplant Unit, St. Vincent's University Hospital, Dublin, Ireland
| | | | | |
Collapse
|
17
|
Barros-Santos T, Libarino-Santos M, Anjos-Santos A, Lins JF, Leite JPC, Pacheco RC, Nascimento-Rocha V, Kisaki ND, Tamura EK, Oliveira-Lima AJ, Berro LF, Uetanabaro APT, Nicoli JR, Marinho EAV. Sex differences in the development of conditioned place preference induced by intragastric alcohol administration in mice. Drug Alcohol Depend 2021; 229:109105. [PMID: 34628094 DOI: 10.1016/j.drugalcdep.2021.109105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The present study aimed to identify for the first time sex differences in the development of CPP induced by intragastric alcohol administration in mice. METHODS Male and female adult Swiss mice were submitted to 16 days of conditioning with alcohol (0.5-3.0 g/kg, N = 8/dose/sex), with 2 post-conditioning tests (after 8 and 16 sessions) during the protocol. RESULTS 8 days of conditioning (4 alcohol sessions, 4 saline sessions) with intragastric alcohol administration were sufficient to induce CPP in male mice at the doses of 1.0, 1.5 and 2.0 g/kg. However, only higher doses (2.0, 2.5 and 3.0 g/kg) induced CPP in female mice using an 8-day conditioning protocol, while a 16-day conditioning protocol was necessary for the development of intragastric alcohol-induced CPP at the doses of 1.0 and 1.5 g/kg. Regardless of the conditioning protocol, higher doses or alcohol that had rewarding effects in females (2.5 and 3.0 g/kg) did not induce CPP in males, with a significant difference between males and females at those doses. Analysis of the potency (EC50) and efficacy (Emax) of alcohol in inducing CPP when administered intragastrically in male and female mice showed significant sex differences with 8 conditioning sessions. CONCLUSIONS Our data show a clear protocol (8 vs 16 days) and dose difference between male and female Swiss mice regarding the development of CPP induced by intragastric alcohol administration. Intragastric alcohol administration is closer to human drinking, and our protocol provides a more translational approach to studying the rewarding effects of alcohol in mice.
Collapse
Affiliation(s)
- Thaísa Barros-Santos
- Department of Biological Sciences, Universidade Estadual de Santa Cruz, Campus Soane Nazaré de Andrade, Rod. Jorge Amado, Km 16, 45662-900, Ilhéus, BA, Brazil
| | - Matheus Libarino-Santos
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-900 Ilhéus, BA, Brazil
| | - Alexia Anjos-Santos
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-900 Ilhéus, BA, Brazil
| | - Juliana F Lins
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-900 Ilhéus, BA, Brazil
| | - João P C Leite
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-900 Ilhéus, BA, Brazil
| | - Roseliz C Pacheco
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-900 Ilhéus, BA, Brazil
| | - Victor Nascimento-Rocha
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-900 Ilhéus, BA, Brazil
| | - Natali D Kisaki
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-900 Ilhéus, BA, Brazil
| | - Eduardo K Tamura
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-900 Ilhéus, BA, Brazil
| | - Alexandre J Oliveira-Lima
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-900 Ilhéus, BA, Brazil
| | - Laís F Berro
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-900 Ilhéus, BA, Brazil; Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA.
| | - Ana Paula T Uetanabaro
- Department of Biological Sciences, Universidade Estadual de Santa Cruz, Campus Soane Nazaré de Andrade, Rod. Jorge Amado, Km 16, 45662-900, Ilhéus, BA, Brazil
| | - Jacques R Nicoli
- Institute of Biological Sciences, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, 31270-901, Pampulha - Belo Horizonte, MG, Brazil
| | - Eduardo A V Marinho
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-900 Ilhéus, BA, Brazil.
| |
Collapse
|
18
|
Leon DA, Yom-Tov E, Johnson AM, Petticrew M, Williamson E, Lampos V, Cox I. What on-line searches tell us about public interest and potential impact on behaviour in response to minimum unit pricing of alcohol in Scotland. Addiction 2021; 116:2008-2015. [PMID: 33394517 DOI: 10.1111/add.15388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/02/2020] [Accepted: 12/23/2020] [Indexed: 11/27/2022]
Abstract
AIMS To investigate whether the introduction of minimum unit pricing (MUP) in Scotland on 1 May 2018 was reflected in changes in the likelihood of alcohol-related queries submitted to an internet search engine, and in particular whether there was any evidence of increased interest in purchasing of alcohol from outside Scotland. DESIGN Observational study in which individual queries to the internet Bing search engine for 2018 in Scotland and England were captured and analysed. Fluctuations over time in the likelihood of specific topic searches were examined. The patterns seen in Scotland were contrasted with those in England. SETTING Scotland and England. PARTICIPANTS People who used the Bing search engine during 2018. MEASUREMENTS Numbers of daily queries submitted to Bing in 2018 on eight alcohol-related topics expressed as a proportion of queries on that day on any topic. These daily likelihoods were smoothed using a 14-day moving average for Scotland and England separately. FINDINGS There were substantial peaks in queries about MUP itself, cheap sources of alcohol and online alcohol outlets at the time of introduction of MUP in May 2018 in Scotland, but not England. These were relatively short-lived. Queries related to intoxication and alcohol problems did not show a MUP peak, but were appreciably higher in Scotland than in England throughout 2018. CONCLUSIONS Analysis of internet search engine queries appears to show that a fraction of people in Scotland may have considered circumventing minimum unit pricing in 2018 by looking for on-line alcohol retailers. The overall higher levels of queries related to alcohol problems in Scotland compared with England mirrors the corresponding differences in alcohol consumption and harms between the countries.
Collapse
Affiliation(s)
- David A Leon
- London School of Hygiene and Tropical Medicine, London, UK.,Department of Community Medicine, UiT, Arctic University of Norway, Tromsø, Norway.,International Laboratory for Population and Health, National Research University Higher School of Economics, Moscow, Russia
| | | | - Anne M Johnson
- Institute of Global Health, University College London, London, UK
| | - Mark Petticrew
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Vasileios Lampos
- Department of Computer Science, University College London, London, UK
| | - Ingemar Cox
- Department of Computer Science, University College London, London, UK.,Centre for Communication and Computing, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
19
|
Singal AK, Arsalan A, Dunn W, Arab JP, Wong RJ, Kuo YF, Kamath PS, Shah VH. Alcohol-associated liver disease in the United States is associated with severe forms of disease among young, females and Hispanics. Aliment Pharmacol Ther 2021; 54:451-461. [PMID: 34247424 DOI: 10.1111/apt.16461] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/12/2021] [Accepted: 05/18/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Alcohol use and alcohol-associated liver disease (ALD) burden are increasing in young individuals. AIM To assess host factors associated with this burden. METHODS National Health and Nutrition Examination Survey (NHANES), National Inpatient Sample (NIS), and United Network for Organ Sharing (UNOS) databases (2006-2016) were used to identify individuals with harmful alcohol use, ALD-related admissions, and ALD-related LT listings respectively. RESULTS Of 15 981 subjects in NHANES database, weighted prevalence of harmful alcohol use was 17.7%, 29.3% in <35 years (G1) versus 16.9% in 35-64 years (G2) versus 5.1% in ≥65 years (G3). Alcohol use was about 11 and 4.7 folds higher in G1 and G2 versus G3, respectively. Male gender and Hispanic race associated with harmful alcohol use. Of 593 600 ALD admissions (5%, 77%, and 18% in G1-G3 respectively), acute on chronic liver failure (ACLF) occurred in 7.2%, (7.2 in G2 vs 6.7% in G1 and G3, P < 0.001). After controlling for other variables, ACLF development among ALD hospitalizations was higher by 14% and 10% in G1 and G2 versus G3, respectively. Female gender and Hispanic race were associated with increased ACLF risk by 8% and 17% respectively. Of 20,245 ALD LT listings (3.4%, 84.4%, and 12.2% in G1-G3 respectively), ACLF occurred in 28% candidates. Risk of severe (grade 2 or 3) ACLF was higher by about 1.7 fold in G1, 1.5 fold in females and 20% in Hispanics. CONCLUSION Young age, female gender, and Hispanic race are independently associated with ALD-related burden and ACLF in the United States. If these findings are validated in prospective studies, strategies will be needed to reduce alcohol use in high risk individuals to reduce burden from ALD.
Collapse
Affiliation(s)
- Ashwani K Singal
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.,Division of Gastroenterology and Hepatology, Avera Transplant Institute, Sioux Falls, SD, USA
| | - Arshad Arsalan
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA
| | - Winston Dunn
- Division of Gastroenterology and Hepatology, Kansas University Medical Center, Kansas City, KS, USA
| | - Juan P Arab
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Palo Alto VA Medical Center, Stanford University, Stanford, CA, USA
| | - Yong-Fang Kuo
- Department of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Vijay H Shah
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
20
|
Blackwood R, Lynskey M, Drummond C. Prevalence and patterns of hospital use for people with frequent alcohol-related hospital admissions, compared to non-alcohol and non-frequent admissions: a cohort study using routine administrative hospital data. Addiction 2021; 116:1700-1708. [PMID: 33245603 DOI: 10.1111/add.15354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/16/2020] [Accepted: 11/22/2020] [Indexed: 01/12/2023]
Abstract
AIMS This study compared prevalence and hospital use among individuals frequently admitted to hospital in England with wholly attributable alcohol-related diagnoses (WAAD), known as alcohol-related frequent attenders (ARFAs), with those of non-alcohol frequent attenders (NAFAs), non-frequent alcohol attenders (ARNFAs) and non-alcohol non-frequent attenders (NANFAs). DESIGN Cross-sectional and longitudinal analyses of 5 years of England's Hospital Episode Statistics (HES). SETTING Hospital inpatients in England, UK, 2011-16. PARTICIPANTS Two cohorts (2011/12 = 489 580/7 654 944 patients and 2015/16 = 490 384/7 660 108 patients) were selected from all adult patients aged ≥ 18 years, treated in English hospitals between 1 April 2011 and 31 March 2016. Patients were categorized as having alcohol-related admissions if diagnoses included a WAAD (ICD-10 classification, WHO, 2016) and frequent admissions if they had more than three hospital admissions during a single HES year. MEASUREMENTS Prevalence of ARFA, number of admissions (spells), occupied bed-days (OBDs), average length of stay (ALOS) and total admission costs over 5 years were compared among ARFAs, ARNFAs, NAFAs and NANFAs. FINDINGS On average, 0.7% of people admitted to hospital per annum in England 2011-15 were ARFAs and more than a quarter of all frequent attenders (for all causes) to hospitals had a wholly attributable alcohol diagnosis on admission. ARFAs had longer ALOS than the other patient groups [5.55 days versus ARNFA 4.7, NAFA 3.39 and NANFA 2.57 days, F = 1088.37 (3, 488 570, P < 0.001)] in the 2015/16 index year; but fewer spells than NAFAs [5.38 ARFAs versus 5.98 NAFAs, F = 20 536.25 (3, 490 380) P < 0.001]. The ARFA cohort reduced in size (from 51 934 ARFAs to 20 548) in the course of 5 years. ARFAs had the highest average total cost of admissions per person over 5 years at £38 189. CONCLUSIONS People with repeated admissions for alcohol-related problems in England appear to be a high-cost, high-need, complex group of patients that makes up more than a quarter of the country's alcohol admissions.
Collapse
Affiliation(s)
- Rosalind Blackwood
- Psychology and Neuroscience, King's College London, National Addiction Centre, Institute of Psychiatry, London, UK
| | - Michael Lynskey
- Psychology and Neuroscience, King's College London, National Addiction Centre, Institute of Psychiatry, London, UK
| | - Colin Drummond
- Psychology and Neuroscience, King's College London, National Addiction Centre, Institute of Psychiatry, London, UK
| |
Collapse
|
21
|
Trefan L, Akbari A, Morgan JS, Farewell DM, Fone D, Lyons RA, Jones Hywel M, Moore SC. Visualisation and optimisation of alcohol-related hospital admissions ICD-10 codes in Welsh e-cohort data. Int J Popul Data Sci 2021; 6:1373. [PMID: 34007894 PMCID: PMC8103565 DOI: 10.23889/ijpds.v6i1.1373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction The excessive consumption of alcohol is detrimental to long term health and increases the likelihood of hospital admission. However, definitions of alcohol-related hospital admission vary, giving rise to uncertainty in the effect of alcohol on alcohol-related health care utilization. Objectives To compare diagnostic codes on hospital admission and discharge and to determine the ideal combination of codes necessary for an accurate determination of alcohol-related hospital admission. Methods Routine population-linked e-cohort data were extracted from the Secure Anonymised Information Linkage (SAIL) Databank containing all alcohol-related hospital admissions (n,= 92,553) from 2006 to 2011 in Wales, United Kingdom. The distributions of the diagnostic codes recorded at admission and discharge were compared. By calculating a misclassification rate (sensitivity-like measure) the appropriate number of coding fields to examine for alcohol-codes was established. Results There was agreement between admission and discharge codes. When more than ten coding fields were used the misclassification rate was less than 1%. Conclusion With the data at present and alcohol-related codes used, codes recorded at admission and discharge can be used equivalently to identify alcohol-related admissions. The appropriate number of coding fields to examine was established: fewer than ten is likely to lead to under-reporting of alcohol-related admissions. The methods developed here can be applied to other medical conditions that can be described using a certain set of diagnostic codes, each of which can be a known sole cause of the condition and recorded in multiple positions in e-cohort data.
Collapse
Affiliation(s)
- Laszl Trefan
- Honorary Research Associate, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff CF14 4YS
| | - Ashley Akbari
- Senior Research Manager and Data Scientist, Health Data Research UK Wales and Northern Ireland, Swansea University Medical School, Institute of Life Science 2, Sketty, Swansea SA2 8QA
| | - Jennifer Siân Morgan
- Performance Analysis Manager, NHS Wales Delivery Unit, Pencoed, Bridgend CF35 5LJ
| | - Daniel Mark Farewell
- Senior Lecturer, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff CF14 4YS
| | - David Fone
- Retired professor, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff CF14 4YS
| | - Ronan A Lyons
- Professor, Health Data Research UK Wales and Northern Ireland, Swansea University Medical School, Institute of Life Science 2, Sketty, Swansea SA2 8QA
| | - Merfyn Jones Hywel
- Research Associate / Statistician, Division of Population Medicine, Cardiff University, Cardiff CF14 4YS
| | - Simon C Moore
- Professor of Public Health Research, Crime and Security Research Institute and School of Dentistry, Cardiff University, Cardiff CF14 4XY
| |
Collapse
|
22
|
Angus C, Pryce R, Holmes J, de Vocht F, Hickman M, Meier P, Brennan A, Gillespie D. Assessing the contribution of alcohol-specific causes to socio-economic inequalities in mortality in England and Wales 2001-16. Addiction 2020; 115:2268-2279. [PMID: 32237009 PMCID: PMC7687183 DOI: 10.1111/add.15037] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/02/2020] [Accepted: 02/28/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS When measuring inequalities in health, public health and addiction research has tended to focus on differences in average life-span between socio-economic groups. This does not account for the extent to which age of death varies between individuals within socio-economic groups or whether this variation differs between groups. This study assesses (1) socio-economic inequalities in both average life-span and variation in age at death, (2) the extent to which these inequalities can be attributed to alcohol-specific causes (i.e. those attributable only to alcohol) and (3) how this contribution has changed over time. DESIGN Cause-deleted life table analysis of national mortality records. SETTING England and Wales, 2001-16. CASES All-cause and alcohol-specific deaths for all adults aged 18+, stratified by sex, age and quintiles of the index of multiple deprivation (IMD). MEASUREMENTS Life expectancy at age 18 yearss and standard deviation in age at death within IMD quintiles and the contribution of alcohol to overall differences in both measures between the highest and lowest IMD quintiles by comparing observed and cause-deleted inequality 'gaps'. FINDINGS In 2016, alcohol-specific causes reduced life expectancy for men and women by 0.26 and 0.14 years, respectively, and increased the standard deviation in age at death. These causes also increased the inequality gap in life expectancy by 0.33 years for men and 0.17 years for women, and variation in age at death by 0.14 years and 0.13 years, respectively. For both measures, the contribution of alcohol to mortality inequalities rose after 2001 and subsequently fell back. For women, alcohol accounted for 3.6% of inequality in age at death and 6.0% of life-span uncertainty, suggesting that using only the former may underestimate alcohol-induced inequalities. There was no comparable difference for men. CONCLUSIONS Deaths from alcohol-specific causes increase inequalities in both life expectancy and variation in age of death between socio-economic groups. Using both measures can provide a fuller picture of overall inequalities in health.
Collapse
Affiliation(s)
- Colin Angus
- Sheffield Alcohol Research Group, School of Health and Related ResearchUniversity of SheffieldSheffieldUK,NIHR School for Public Health Research
| | - Rob Pryce
- Sheffield Alcohol Research Group, School of Health and Related ResearchUniversity of SheffieldSheffieldUK,NIHR School for Public Health Research
| | - John Holmes
- Sheffield Alcohol Research Group, School of Health and Related ResearchUniversity of SheffieldSheffieldUK,NIHR School for Public Health Research
| | - Frank de Vocht
- NIHR School for Public Health Research,School of Social and Community MedicineBristolUK
| | - Matthew Hickman
- NIHR School for Public Health Research,School of Social and Community MedicineBristolUK
| | - Petra Meier
- Sheffield Alcohol Research Group, School of Health and Related ResearchUniversity of SheffieldSheffieldUK,NIHR School for Public Health Research
| | - Alan Brennan
- Sheffield Alcohol Research Group, School of Health and Related ResearchUniversity of SheffieldSheffieldUK,NIHR School for Public Health Research
| | - Duncan Gillespie
- Sheffield Alcohol Research Group, School of Health and Related ResearchUniversity of SheffieldSheffieldUK,NIHR School for Public Health Research
| |
Collapse
|
23
|
|
24
|
Myran DT, Hsu AT, Smith G, Tanuseputro P. Rates of emergency department visits attributable to alcohol use in Ontario from 2003 to 2016: a retrospective population-level study. CMAJ 2020; 191:E804-E810. [PMID: 31332048 DOI: 10.1503/cmaj.181575] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2019] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Alcohol use causes a large burden on the health of Canadians, and alcohol-related harms appear to be increasing in many high-income countries. We sought to analyze changes in emergency department visits attributable to alcohol use, by sex, age and neighbourhood income over time. METHODS All individuals aged 10 to 105 years living in Ontario, Canada, between 2003 and 2016 were included in this study. The primary outcome was age-standardized rates of emergency department visits attributable to alcohol use, defined using diagnostic codes from the Canadian Institute for Health Information Health Indicator "hospitalizations entirely caused by alcohol." We compared rates of these visits using a retrospective population-level design. RESULTS Among 15 121 639 individuals, there were 765 346 emergency department visits attributable to alcohol use over the study period. Between 2003 and 2016, the age-standardized rates of these visits increased more in women (86.5%) than in men (53.2%), and the increase in rates of emergency department visits attributable to alcohol use was 4.4 times greater than the increases in the rates of overall emergency department visits. Individuals aged 25-29 years experienced the largest change in the rate of emergency department visits attributable to alcohol use (175%). We found evidence of age-cohort effects, whereby the rate of emergency department visits attributable to alcohol use at age 19 years increased on average by 4.07% (95% confidence interval [CI] 3.71%-4.44%) per year for each cohort born between 1986 and 1999. Individuals in the lowest neighbourhood income quintile had 2.37 (95% CI 2.27-2.49) times the rate of emergency department visits attributable to alcohol use than those in the highest income quintile. This disparity increased slightly over the study period. INTERPRETATION Although men and lower-income individuals have the highest burden of emergency department visits attributable to alcohol use, the largest increases in visits have been in women and younger adults. Further research should focus on potential causes of these trends to provide guidance on how to reduce alcohol-related harms.
Collapse
Affiliation(s)
- Daniel T Myran
- School of Epidemiology and Public Health (Myran), Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program (Hsu, Smith), The Ottawa Hospital, Ottawa Hospital Research Institute; ICES uOttawa (Smith); Bruyère Research Institute (Hsu, Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont.
| | - Amy T Hsu
- School of Epidemiology and Public Health (Myran), Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program (Hsu, Smith), The Ottawa Hospital, Ottawa Hospital Research Institute; ICES uOttawa (Smith); Bruyère Research Institute (Hsu, Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Glenys Smith
- School of Epidemiology and Public Health (Myran), Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program (Hsu, Smith), The Ottawa Hospital, Ottawa Hospital Research Institute; ICES uOttawa (Smith); Bruyère Research Institute (Hsu, Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Peter Tanuseputro
- School of Epidemiology and Public Health (Myran), Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program (Hsu, Smith), The Ottawa Hospital, Ottawa Hospital Research Institute; ICES uOttawa (Smith); Bruyère Research Institute (Hsu, Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| |
Collapse
|
25
|
Libarino-Santos M, de Santana Santos ACG, Cata-Preta EG, Barros-Santos T, Nunes Brandão NR, Borges ALN, Santos-Baldaia R, Hollais AW, Baldaia MA, Berro LF, Marinho EAV, Frussa-Filho R, Oliveira-Lima AJ. Role of the treatment environment in the effects of aripiprazole on ethanol-induced behavioral sensitization and conditioned place preference in female mice. Drug Alcohol Depend 2020; 208:107856. [PMID: 31954952 DOI: 10.1016/j.drugalcdep.2020.107856] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/11/2019] [Accepted: 12/30/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Evidence suggests that aripiprazole, a partial dopamine D2 and serotonin 5-HT1A receptor agonist and 5-HT2A receptor antagonist, show significant efficacy in reducing alcohol use. We have previously demonstrated that treatment with aripiprazole blocked the reinstatement of cocaine-induced behavioral sensitization in a context-dependent manner, suggesting that the treatment environment may modulate the therapeutic effects of aripiprazole. The present study aimed to evaluate the effects of treatment with aripiprazole on ethanol-induced behavioral sensitization and conditioned place preference in female mice, and the role of the treatment environment in those effects. METHODS Adult female mice were either sensitized with ethanol injections in the open-field apparatus, or conditioned with ethanol in the conditioned place preference (CPP) apparatus. Animals were then treated with vehicle or 0.1 mg/kg aripiprazole paired to the test environment (open-field or CPP apparatus) or not (home-cage treatments) for 4 alternate days, and the subsequent expression of behavioral sensitization or CPP to ethanol was evaluated during or following an ethanol re-exposure, respectively. RESULTS Repeated treatment with aripiprazole attenuated the expression of ethanol-induced behavioral sensitization regardless of the treatment environment. Treatment with aripiprazole was only effective at preventing the reinstatement of ethanol-induced CPP when paired with the ethanol-associated environment, but not when administered in the home-cage. CONCLUSIONS The present findings corroborate previous studies suggesting the effectiveness of aripiprazole for the treatment of alcohol use disorder. Our results also point to an important role of the treatment environment in the therapeutic effects of aripiprazole in rodent models of ethanol abuse.
Collapse
Affiliation(s)
| | | | | | - Thaísa Barros-Santos
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Ilhéus, BA, Brazil
| | | | | | - Renan Santos-Baldaia
- Department of Pharmacology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - André W Hollais
- Department of Pharmacology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Marilia A Baldaia
- Department of Pharmacology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Laís F Berro
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Ilhéus, BA, Brazil; Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States.
| | - Eduardo A V Marinho
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Ilhéus, BA, Brazil
| | - Roberto Frussa-Filho
- Department of Pharmacology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | |
Collapse
|
26
|
Ball J. Commentary on Chan et al. (2020): Solving the puzzle of why substance use is declining among young people requires a multi-substance perspective. Addiction 2020; 115:156-157. [PMID: 31677189 DOI: 10.1111/add.14817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Jude Ball
- Department of Public Health, University of Otago, Wellington, New Zealand
| |
Collapse
|
27
|
Ventura-Cots M, Ballester-Ferré MP, Ravi S, Bataller R. Public health policies and alcohol-related liver disease. JHEP Rep 2019; 1:403-413. [PMID: 32039391 PMCID: PMC7005647 DOI: 10.1016/j.jhepr.2019.07.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/23/2019] [Accepted: 07/30/2019] [Indexed: 12/11/2022] Open
Abstract
Alcohol-related liver disease (ALD) represents a major public health problem worldwide. According to the World Health Organization, the highest levels of per capita alcohol consumption are observed in countries of the European Region. Alcohol consumption is also alarmingly increasing in developing countries. ALD is one of the main contributors to the burden of alcohol-attributable deaths and disability. In the United States, severe forms of ALD such alcoholic hepatitis have increased in the last decade and in the United Kingdom, three-quarters of liver-related mortality results from alcohol consumption. Besides genetic factors, there is strong evidence that the amount of alcohol consumed plays a major role in the development of advanced ALD. Establishing effective public health policies is therefore mandatory to reduce the burden of ALD. Since the 90s, major public health institutions and governments have developed a variety of policies in order to reduce the harm caused by excessive drinking. These policies encompass multiple factors, from pricing and taxation to advertising regulation. Measures focused on taxation and price regulation have been shown to be the most effective at reducing alcohol-related mortality. However, there are few studies focused on the effect of public policies on ALD. This review article summarises the factors influencing ALD burden and the role of different public health policies.
Collapse
Affiliation(s)
- Meritxell Ventura-Cots
- Center for Liver Diseases, Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Samhita Ravi
- Center for Liver Diseases, Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ramon Bataller
- Center for Liver Diseases, Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
28
|
Trefan L, Gartner A, Alcock A, Farewell D, Morgan J, Fone D, Paranjothy S. Epidemiology of alcohol-related emergency hospital admissions in children and adolescents: An e-cohort analysis in Wales in 2006-2011. PLoS One 2019; 14:e0217598. [PMID: 31163052 PMCID: PMC6548373 DOI: 10.1371/journal.pone.0217598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/14/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Harmful levels of alcohol consumption in young people are prevalent and of increasing public concern in the western world. Rates of alcohol-related emergency hospital admissions in children and young people between 10 to 17 years were described, and the reasons for these admissions and their association with socio-demographic factors were examined. METHODS E-cohort data were extracted from the Secure Anonymised Information Linkage Databank, which contained alcohol-related emergency hospital admissions (N = 2968) from 2006 to 2011 in children and adolescents aged 10 to 17 years in Wales. A generalised linear mixed model was fitted using a log-link with a population offset to the data to calculate incident rate ratios (IRRSs). RESULTS There was a general decreasing trend from 2006 to 2011 in the number and rate of alcohol-related emergency hospital admissions; the mean age of admission was 15.4 (standard deviation 1.4) years. In each of the four youngest age groups (10-13,14,15,16 years), females had higher IRRs than males. Males had slightly higher IRR compared to females only in the oldest age group (17 years). IRRs increased with increasing deprivation. The majority (92%) of the admissions lasted one day and most of the admissions (70%) occured during the last three days of the week with a peak on Saturday. The length of stay in hospital was longer in cases when self-harm were present. Multiple admissions showed high prevalance of serious self-harm cases in females. The number of admissions with injuries and falls were higher for males than females. CONCLUSION Female children and adolescents were more likely to be admitted to hospital for alcohol-related reasons. These data illustrate the significant burden of alcohol-related harm in young people and highlight the need for interventions and policies that promote safe drinking practices among young people to prevent future alcohol-related harm during the life-course.
Collapse
Affiliation(s)
- Laszlo Trefan
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Andrea Gartner
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Amy Alcock
- Royal Gwent Hospital, Newport, United Kingdom
| | - Daniel Farewell
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | | | - David Fone
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Shantini Paranjothy
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| |
Collapse
|
29
|
Fitzgerald N, Egan M, de Vocht F, Angus C, Nicholls J, Shortt N, Nichols T, Maani Hessari N, McQuire C, Purves R, Critchlow N, Mohan A, Mahon L, Sumpter C, Bauld L. Exploring the impact of public health teams on alcohol premises licensing in England and Scotland (ExILEnS): procotol for a mixed methods natural experiment evaluation. BMC Med Res Methodol 2018; 18:123. [PMID: 30400776 PMCID: PMC6219046 DOI: 10.1186/s12874-018-0573-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 10/12/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Recent regulatory changes in the system by which premises are licensed to sell alcohol, have given health representatives a formal role in the process in England and Scotland. The degree to which local public health teams engage with this process varies by locality in both nations, which have different licensing regimes. This study aims to critically assess the impact on alcohol-related harms - and mechanisms - of public health stakeholders' engagement in alcohol premises licensing from 2012 to 2018, comparing local areas with differing types and intensities of engagement, and examining practice in Scotland and England. METHODS The study will recruit 20 local authority areas where public health stakeholders have actively engaged with the alcohol premises licensing system (the 'intervention') and match them to a group of 20 lower activity areas using genetic matching. Four work packages are included: (1) Structured interviews and documentary analysis will examine the type and level of intervention activity from 2012 to 2018, creating a novel composite measure of the intensity of such activity and will assess the local licensing system and potential confounding activities over the same period. In-depth interviews with public health, licensing, police and others will explore perceived mechanisms of change, acceptability, and impact. (2) Using longitudinal growth models and time series analyses, the study will evaluate the impact of high and low levels of activity on alcohol-related harms using routine data from baseline 2009 to 2018. (3) Intervention costs, estimated National Health Service cost savings and health gains will be evaluated using the Sheffield Alcohol Policy Model to estimate impact on alcohol consumption and health inequalities. (4) The study will engage public health teams to create a new theory of change for public health involvement in the licensing process using our data. We will share findings with local, national and international stakeholders. DISCUSSION This interdisciplinary study examines, for the first time, whether and how public health stakeholders' involvement in alcohol licensing impacts on alcohol harms. Using mixed methods and drawing on complex systems thinking, it will make an important contribution to an expanding literature evaluating interventions not suited to traditional epidemiological research.
Collapse
Affiliation(s)
- Niamh Fitzgerald
- Institute of Social Marketing, UK Centre for Tobacco & Alcohol Studies, University of Stirling, Stirling, FK9 4LA UK
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Niamh Shortt
- School of Geosciences, University of Edinburgh, Edinburgh, UK
| | - Tim Nichols
- formerly Brighton & Hove City Council, Brighton, UK
| | - Nason Maani Hessari
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Cheryl McQuire
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Richard Purves
- Institute of Social Marketing, University of Stirling, Stirling, UK
| | - Nathan Critchlow
- Institute of Social Marketing, University of Stirling, Stirling, UK
| | - Andrea Mohan
- Institute of Social Marketing, University of Stirling, Stirling, UK
| | | | - Colin Sumpter
- Institute of Social Marketing, University of Stirling, Stirling, UK
| | - Linda Bauld
- Institute of Social Marketing, UK Centre for Tobacco & Alcohol Studies, University of Stirling, Stirling, FK9 4LA UK
| |
Collapse
|
30
|
Maheswaran R, Green MA, Strong M, Brindley P, Angus C, Holmes J. Alcohol outlet density and alcohol related hospital admissions in England: a national small-area level ecological study. Addiction 2018; 113:2051-2059. [PMID: 30125420 PMCID: PMC6220934 DOI: 10.1111/add.14285] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/06/2018] [Accepted: 05/29/2018] [Indexed: 12/02/2022]
Abstract
BACKGROUND AND AIMS Excessive alcohol consumption has a substantial impact on public health services. A key element determining alcohol availability is alcohol outlet density. This study investigated the relationship between on-trade and off-trade outlets and hospital admission rates in local neighbourhoods. DESIGN National small-area level ecological study. SETTING AND PARTICIPANTS All 32 482 lower layer super output census areas (LSOAs) in England (42 227 108 million people aged 15+ years). Densities for six outlet categories (outlets within a 1-km radius of residential postcode centroids, averaged for all postcodes within each LSOA) were calculated. MEASUREMENTS Main outcome measures were admissions due to acute or chronic conditions wholly or partially attributable to alcohol consumption from 2002/03 to 2013/14. FINDINGS There were 1 007 137 admissions wholly, and 2 153 874 admissions partially, attributable to alcohol over 12 years. After adjustment for confounding, higher densities of on-trade outlets (pubs, bars and nightclubs; restaurants licensed to sell alcohol; other on-trade outlets) and convenience stores were associated with higher admission rate ratios for acute and chronic wholly attributable conditions. For acute wholly attributable conditions, admission rate ratios were 13% (95% confidence interval = 11-15%), 9% (7-10%), 12% (10-14%) and 10% (9-12%) higher, respectively, in the highest relative to the lowest density categories by quartile. For chronic wholly attributable conditions, rate ratios were 22% (21-24%), 9% (7-11%), 19% (17-21%) and 7% (6-9%) higher, respectively. Supermarket density was associated with modestly higher acute and chronic admissions but other off-trade outlet density was associated only with higher admissions for chronic wholly attributable conditions. For partially attributable conditions, there were no strong patterns of association with outlet densities. CONCLUSIONS In England, higher densities of several categories of alcohol outlets appear to be associated with higher hospital admission rates for conditions wholly attributable to alcohol consumption.
Collapse
Affiliation(s)
- Ravi Maheswaran
- Public Health GIS Unit, School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Mark A. Green
- Department of Geography and PlanningUniversity of LiverpoolLiverpoolUK
| | - Mark Strong
- Public Health GIS Unit, School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Paul Brindley
- Department of LandscapeUniversity of SheffieldSheffieldUK
| | - Colin Angus
- Sheffield Alcohol Research Group, School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - John Holmes
- Sheffield Alcohol Research Group, School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| |
Collapse
|
31
|
Ng Fat L, Shelton N, Cable N. Investigating the growing trend of non-drinking among young people; analysis of repeated cross-sectional surveys in England 2005-2015. BMC Public Health 2018; 18:1090. [PMID: 30301472 PMCID: PMC6178254 DOI: 10.1186/s12889-018-5995-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 08/24/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Non-drinking among young people has increased over the past decade in England, yet the underlying factor driving this change is unknown. Traditionally non-drinking has been found to be associated with lower socio-economic status and poorer health. This study explores among which sub-groups non-drinking has increased, and how this correlates with changes in drinking patterns, to identify whether behaviours are becoming more polarised, or reduction is widespread among young people. METHODS Among participants aged 16 to 24 years (N = 9699), within the annual cross-sectional nationally-representative Health Survey for England 2005-2015 datasets, the following analyses were conducted: 1) The proportion of non-drinkers among social-demographic and health sub-groups by year, and tests for linear trends among sub-groups, adjusting for age were calculated. In pooled analyses, an interaction between year and each variable was modelled in sex- and age-adjusted logistic regression models on the odds of being a non-drinker versus drinker 2) At the population level, spearman correlation co-efficients were calculated between the proportion non-drinking and the mean alcohol units consumed and binge drinking on the heaviest drinking day, by year. Ordinary least squares regression analyses were used, modelling the proportion non-drinking as the independent variable, and the mean units/binge drinking as the dependent variable. RESULTS Rates of non-drinking increased from 18% (95%CI 16-22%) in 2005 to 29% (25-33%) in 2015 (test for trend; p < 0.001), largely attributable to increases in lifetime abstention. Not drinking in the past week increased from 35% (32-39%) to 50% (45-55%) (p < 0.001). Significant linear increases in non-drinking were found among most sub-groups including healthier sub-groups (non-smokers, those with high physical activity and good mental health), white ethnicity, north and south regions, in full-time education, and employed. No significant increases in non-drinking were found among smokers, ethnic minorities and those with poor mental health. At the population-level, significant negative correlations were found between increases in non-drinking and declines in the mean units consumed (ρ = - 0.85, p < 0.001), and binge drinking (ρ = - 0.87, p < 0.001). CONCLUSION Increases in non-drinking among young people has coincided with a delayed initiation into alcohol consumption, and are to be welcomed. Future research should explore attitudes towards drinking among young people.
Collapse
Affiliation(s)
- Linda Ng Fat
- Department of Epidemiology and Public Health, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Nicola Shelton
- Department of Epidemiology and Public Health, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Noriko Cable
- Department of Epidemiology and Public Health, 1-19 Torrington Place, London, WC1E 7HB UK
| |
Collapse
|
32
|
Tunissiolli NM, Castanhole-Nunes MMU, Pavarino ÉC, da Silva RF, da Silva RDCMA, Goloni-Bertollo EM. Clinical, Epidemiological and Histopathological Aspects in Patients with Hepatocellular Carcinoma Undergoing Liver Transplantation. Asian Pac J Cancer Prev 2018; 19. [PMID: 30360608 PMCID: PMC6291045 DOI: 10.22034/apjcp.2018.19.10.2795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Hepatocellular Carcinoma (HCC) is the primary liver cancer with high incidence and mortality rates.
Currently one of the major etiologies for liver disease, HCC and liver transplantation is nonalcoholic fatty liver disease
(NAFLD). The aim of the present study was to evaluate the epidemiological, histopathological and clinical aspects of
HCC transplant patients, with emphasis on NAFLD etiology. Methods: This study included all HCC patients submitted
to liver transplantation from 2010 to 2016 of the University Reference Center. The analyzed variables were age, gender,
ethnicity, causes that led to liver transplantation, alpha-fetoprotein (AFP) dosage, histological aspects, recurrence,
survival and NAFLD. Results: A total of 60 patients were included in the study being 80% men with a mean age of
58.3 ± 10.6 years. All patients were cirrhotic. The causes that led to the transplantation were the presence of the hepatitis
C virus (HCV) (56.6% of the patients), an association of the virus with alcohol (20%), the presence of the hepatitis B
virus (HBV) (20%), alcoholic liver disease (ALD) (50.9%) and NAFLD (25%). Of the latter, eight were diagnosed
pre-transplantation and seven were NAFLD carriers without a previous diagnosis. Regarding the Edmondson-Steiner
histological classification, 58.5% of the patients were classified as grade ≤ II. Conclusions: There is predominance of
male patients with a mean age of 58.3 years. Degree ≤ II is the most frequent to the Edmondson-Steiner histological
classification in the evaluated casuistic. HCV, ALD and NAFLD is the most common etiological agents found in the
study. The (high) underestimated prevalence of NAFLD in the pre-transplanted patients is due to the fact that all patients
presented cirrhosis, masking NAFLD signals.
Collapse
Affiliation(s)
| | | | | | - Renato Ferreira da Silva
- Department of Surgery and Liver Transplantation, Hospital de Base/FUNFARME, Sao Jose do Rio Preto Medical School (FAMERP), Sao Jose do Rio Preto, Brazil
| | - Rita de Cássia Martins Alves da Silva
- Department of Surgery and Liver Transplantation, Hospital de Base/FUNFARME, Sao Jose do Rio Preto Medical School (FAMERP), Sao Jose do Rio Preto, Brazil
| | - Eny Maria Goloni-Bertollo
- Research Unit of Genetics and Molecular Biology (UPGEM), Sao Jose do Rio Preto, Brazil,For Correspondence:
| |
Collapse
|
33
|
Silva AAF, Barbosa-Souza E, Confessor-Carvalho C, Silva RRR, De Brito ACL, Cata-Preta EG, Silva Oliveira T, Berro LF, Oliveira-Lima AJ, Marinho EAV. Context-dependent effects of rimonabant on ethanol-induced conditioned place preference in female mice. Drug Alcohol Depend 2017; 179:317-324. [PMID: 28837947 DOI: 10.1016/j.drugalcdep.2017.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 07/12/2017] [Accepted: 07/20/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND The CB1 receptor antagonist rimonabant has been previously found to prevent behavioral effects of drugs of abuse in a context-dependent manner, suggesting an important role of endocannabinoid signaling in drug-induced environmental conditioning. The aim of the present study was to evaluate the effects of rimonabant on ethanol-induced conditioned place preference (CPP) in female mice. METHODS Animals were conditioned with saline or ethanol (1.8g/kg) during 8 sessions, and subsequently treated with either saline or rimonabant (1 or 10mg/kg) in the CPP environment previously associated with saline (unpaired) or ethanol (paired) for 6 consecutive days. Animals were then challenged with ethanol (1.8g/kg) in the ethanol-paired environment and ethanol-induced CPP was quantified on the following day. RESULTS While treatment with 1mg/kg rimonabant in the saline-associated environment had no effects on the subsequent expression of ethanol-induced CPP, it blocked the expression of CPP to ethanol when paired to the ethanol-associated environment. When given in the ethanol-paired environment, 10mg/kg rimonabant induced aversion to the ethanol-associated environment. The same aversion effect was observed for 10mg/kg rimonabant when given in the saline-associated environment, thereby potentiating the expression of ethanol-induced CPP. Importantly, rimonabant did not induce CPP or conditioned place aversion on its own. Controlling for the estrous cycle phase showed no influences of hormonal cycle on the development and expression of ethanol-induced CPP. CONCLUSIONS Our data suggest that rimonabant reduces the rewarding properties of ethanol by abolishing drug-environment conditioning in the CPP paradigm in a context-dependent manner.
Collapse
Affiliation(s)
- Aline A F Silva
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-0, Ilhéus, BA, Brazil
| | - Evelyn Barbosa-Souza
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-0, Ilhéus, BA, Brazil
| | - Cassio Confessor-Carvalho
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-0, Ilhéus, BA, Brazil
| | - Raiany R R Silva
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-0, Ilhéus, BA, Brazil
| | - Ana Carolina L De Brito
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-0, Ilhéus, BA, Brazil
| | - Elisangela G Cata-Preta
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-0, Ilhéus, BA, Brazil
| | - Thaynara Silva Oliveira
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-0, Ilhéus, BA, Brazil
| | - Lais F Berro
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 N State St, Jackson, MS, 39216, USA.
| | - Alexandre J Oliveira-Lima
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-0, Ilhéus, BA, Brazil
| | - Eduardo A V Marinho
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Rod. Ilhéus/Itabuna, Km 16, 45662-0, Ilhéus, BA, Brazil.
| |
Collapse
|