Alcohol use and alcohol related harm in Northern Ireland - April 2011

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1 Alcohol use and alcohol related harm in Northern Ireland - April 2011 Northern Ireland has seen a notable increase in the number of people drinking alcohol and in the number of people drinking in excess of the recommended daily limit. Changes in licensing laws, the effects of the peace process and the rapid growth of the leisure industry have been noted as possible reasons why consumption in Northern Ireland has increased at a much greater pace than the rest of the UK. Alcohol misuse generates overall social costs of 679.8m per annum in Northern Ireland across the areas of healthcare ( 122.2m), social work ( 48.5m), fire and police services ( 223.6m), courts and prisons ( 83.8m), and the wider economy ( 201.7m). Alcohol consumption in Northern Ireland Around seven out of ten adults drink alcohol (All-74%, M-79%, F-70% CHS; All-72%, M-74%, F-70% ADP 2008). Four in five adult drinkers exceed the recommended daily limits (All-81%, M-79%, F- 83%) and nearly one quarter exceeds weekly sensible levels (All-24%, M-26%, F- 22%). Younger adults (18-29 years) are more likely than older adults (60-75 years) to drink (83% vs 54%), to exceed the weekly guidelines for sensible drinking (35% vs 16%) and to binge drink (54% vs 16%). Over half (55%) of pupils reported ever having drunk alcohol, with no significant difference in lifetime prevalence between boys (55%) and girls (56%). Among pupils who have ever drunk alcohol, over half (55%) reported being drunk on at least one occasion. Girls (58%) were more likely to report ever being drunk than boys (51%). Over one quarter (27%) of pupils who have ever drunk alcohol, have bought alcohol themselves; girls (31%) are more likely to report buying alcohol than boys (24%). Between 1986 and 2008/09 the prevalence of drinking has increased from 64% to 74%, with a greater increase among females (58% to 70%) than males (72% to 79%). Alcohol price and expenditure in the UK Alcohol was 66% more affordable in 2009 than in 1987, with off trade alcohol becoming much more affordable than on trade alcohol. Household purchases of alcoholic drinks rose by 5.5% in Within the UK, Northern Ireland has the lowest total expenditure on alcoholic drinks but the highest level of spending on alcoholic drinks consumed outside the house ( 3.41 per person per week).

2 Alcohol related mortality In 2010, there were 284 alcohol related deaths registered in Northern Ireland, 191 male and 93 female. Between 1999 and 2009, 31% of alcohol related deaths were among those aged years and a further 26% were among those aged 55 to 64 years. Between 1999 and 2010 the number of alcohol related deaths has increased; the annual average number of alcohol related deaths registered between 1999 and 2001 was 190, this compares to an annual average of 281 alcohol related deaths registered between 2008 and 2010, a 48 per cent increase. Between 2001 and 2009, 70% of alcohol related deaths were other alcohol related deaths such as alcoholic liver disease and a further 27% were due to mental and behavioural disorders due to alcohol use. In 2009, the highest rate of alcohol related deaths (crude rate per 100,000) was recorded for the Belfast Trust/LCG (22.4), followed by the Western Trust/LCG (18.1), the South Eastern Trust/LCG (16.3), the Northern Trust/LCG (12.7) and the Southern Trust/LCG (11.3). Using combined data for , the highest rates of alcohol related deaths (crude rate per 100,000) were recorded for Belfast LGD (26.4), Derry LGD (21.0), Ards LGD (16.4), Ballymoney LGD (16.2) and North Down LGD (15.5). Between 2005 and 2008(p) the alcohol related death rate; rose by around 10% in both deprived areas (28.6 to 31.4 per 100,000) and Northern Ireland (12.9 to 14.2 per 100,000). The deprived death rate has remained large at around 120% higher than the NI rate. increased in rural areas by 13% from 6.9 to 7.8 per 100,000. The rural inequality gap remained fairly steady and stood at 45% in 2008(p). Those living in the most deprived communities are around four times more likely to die from alcohol related mortality than those who live in the least deprived areas. In terms of life expectancy, relatively higher alcohol related mortality in the most deprived areas than regionally contributed 0.6 years to the male deprivation gap and 0.2 years to the female gap in Alcohol related hospital admissions In 2009/10 there were 3,475 admissions to acute hospitals in Northern Ireland with a primary alcohol related diagnosis; The rate of admissions is around 2.5 times higher for males compared to females; in 2009/10 there were 2,523 male (250 per 100,000) and 952 female (105 per 100,000) admissions with a primary alcohol related diagnosis. The number of alcohol related admissions has increased between 2000/01 and 2009/10, with greater increases among females: primary alcohol related diagnosis by 54% (females 68%, males 49%). any alcohol related diagnosis by 61%, (females 68%, males 58%). Between 1999/00 and 2009/10 the rate of admissions (any diagnosis) for: mental or behavioural disorders due to alcohol (F10) have increased by 53% from 255 to 398 per 100,000; males 402 to 600 per 100,000 and females from per 100,000). alcoholic liver disease (K70) has increased by 89% (from 34 to 63 per 100,000; males 60 to 82 per 100,000, females from 17 to 45 per 100,000).

3 Contents Page Introduction 1 Drinking patterns in the UK 3 The social costs of alcohol misuse in Northern Ireland 4 Alcohol consumption in Northern Ireland 5 - Continuous household survey 5 - Adult drinking patterns in Northern Ireland key findings 6 - Young persons behaviour and attitudes survey (YPBAS) 7 Alcohol pricing and expenditure 10 Alcohol related mortality in the United Kingdom 12 Alcohol related mortality in Northern Ireland 13 - Alcohol related mortality by Health and Social Care Trust / Local Commissioning Group and Local Government District Alcohol related mortality and inequality - Health and Social Care Inequalities Monitoring System Alcohol related mortality by Health and Social Care Trust 17 Alcohol mortality and life expectancy 20 Hospital admissions for alcohol related harm 21 - Variation by age 22 - Variation by diagnosis 23 Treatment for alcohol misuse in Northern Ireland 24 Drug misuse database (DMD) 24 Road traffic accidents 25 Appendix 26 References 39 Further sources of information 40

4 Introduction The Global status report on alcohol and health 2011 presents a comprehensive perspective on the global, regional and country consumption of alcohol, patterns of drinking, health consequences and policy responses in Member States. 1 The full report and country profiles can be downloaded at the following links; The hazardous and harmful use of alcohol is a major global contributing factor to death, disease and injury: to the drinker through health impacts, such as alcohol dependence, liver cirrhosis, cancers and injuries; and to others through the dangerous actions of intoxicated people, such as drink driving and violence or through the impact of drinking on fetus and child development. The harmful use of alcohol results in approximately 2.5 million deaths each year, with a net loss of life of 2.25 million, taking into account the estimated beneficial impact of low levels of alcohol use on some diseases in some population groups. Harmful drinking can also be very costly to communities and societies. Alcohol consumption and problems related to alcohol vary widely around the world, but the burden of disease and death remains significant in most countries. Alcohol consumption is the world s third largest risk factor for disease and disability; in middle-income countries, it is the greatest risk. Alcohol is a causal factor in 60 types of diseases and injuries and a component cause in 200 others. Almost 4% of all deaths worldwide are attributed to alcohol, greater than deaths caused by HIV/AIDS, violence or tuberculosis. Alcohol is also associated with many serious social issues, including violence, child neglect and abuse, and absenteeism in the workplace. In 2006, the Health and Consumer Protection Directorate-General of the European Commission commissioned a poll to obtain a picture of EU citizens alcohol drinking habits and their attitudes towards measures potentially influencing alcohol related harm. One third of UK respondents, reported drinking 2-3 times per week, the highest percentage of in the EU25 (Figure 2). 2 1

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6 Drinking patterns in the UK There has been a decline in the prevalence of drinking over the last decade in Great Britain as a whole, with greater change observed in younger adults (aged 16 to 24 and 25 to 44 years). In contrast, there was a notable increase in the prevalence of drinking in Northern Ireland in the last two decades in both men and women, and across all adult age groups, but especially in the younger adults (aged 16 to 24 years) and 45 to 64-year-old women. From 1988 to 2006, there has been an overall increase in drinking in excess of recommended weekly limits for men and women in Great Britain, taking into consideration revised methods for unit calculation. The change is more marked in women than in men. In contrast, for men and women in Northern Ireland, there has been an increase in the proportion exceeding recommended weekly limits over a longer time span from 1988 to The steepest increase occurred in young adults aged 18 to 24 years, with older age groups showing less change for men and women. 3 Table 1 presents summary details of current adult drinking patterns in Northern Ireland, England, Scotland and Wales, in relation to the prevalence, frequency and level of alcohol consumption, as well as mortality rates associated with alcohol misuse. There are a number of technical differences in the definitions used for reporting the data for Northern Ireland and Great Britain and the analysis should therefore be viewed as a high-level review of drinking patterns across the four jurisdictions, rather than an exact comparison. 4 Table 1: Adult Drinking Patterns in Northern Ireland, England, Scotland and Wales Daily drinking Adults who drank alcohol at least once in the past week (%) Adults who drank alcohol on five or more days in the past week (%) Adults exceeding recommended daily limit at least once in past week (%) Adults exceeding twice recommended daily limit at least Northern Ireland England Scotland Wales Great Britain once in past week (%) Weekly drinking Average units consumed per week Males 18.6 n/a 18 n/a n/a Females 11.6 n/a 8.6 n/a n/a Adults who drank above hazardous weekly limits in averageweek (%) 12 n/a 25 n/a n/a Adults who drank above harmful 3 n/a 18 n/a n/a weekly limits in average week (%) Alcohol-related death rate per 100,000 population Males Females Sources: DHSSPS Adult Drinking Patterns Survey and ONS General Lifestyle Survey 3

7 The social costs of alcohol misuse in Northern Ireland Reducing the harm caused by alcohol misuse is a very significant element of the public health agenda in Northern Ireland. The Institute of Alcohol Studies has estimated that alcohol is a bigger factor than high cholesterol levels, obesity, diabetes and asthma in causing ill-health and premature deaths in Europe, accounting for almost 10% of these deaths. 5 Aside from its human cost, alcohol misuse is likely to place a significant burden of additional expenditure on the public services, in a wide range of areas, such as healthcare, public safety, social work and criminal justice, as well as generating other costs in the wider economy. 4 Recent studies have estimated the annual cost of alcohol misuse in Scotland and England to be 3.6bn and 2.7bn respectively, a per-capita cost of 53 to the health service. 6,7 Table 2 provides cost estimates for Northern Ireland. It shows calculations with and without adjustment for the Northern Ireland context, taking into account assumptions based on evidence from recent studies in Great Britain, particularly Scotland. Table 2: Overall summary of cost estimates (With and Without Adjustment) Cost element With adjustment m Without adjustment m GP-prescribed drugs GP/pactice nurse consultations attributable to alcohol Laboratory testing in primary care Hospitalisation days acute Hospitalisation days mental illness A&E attendances Outpatient hospital visits Day hospital visits mental illness <0.1 <0.1 Day hospital visits non-mental illness Community psychiatric teams Health promotion Drug and alcohol coordination teams Ambulance journeys Total estimated cost to healthcare Children and family services Youth justice Criminal justice social work Total estimated cost to social work Fire service callouts Policing for alcohol related crime Policing for violent crime partly related to alcohol Policing for other crime partly related to alcohol Total estimated cost to fire and police services Court costs for violent crime related to alcohol Court costs for other crime related to alcohol Public prosecution violent crime related to alcohol Public prosecution costs for other crime related to alcohol Legal Aid costs for violent crime related to alcohol Legal Aid costs for other crime related to alcohol Prison costs for violent crime related to alcohol Prison costs for other crime related to alcohol Total estimated cost to courts and prisons Presenteeism at work Absenteeism from work Unemployment Premature mortality among people of working age Total estimated cost to wider economy Total estimated cost

8 Alcohol consumption in Northern Ireland The main sources of information on alcohol consumption in adults in Northern Ireland are the Continuous Household Survey (replaced by the Northern Ireland Health Survey in 2010) and the Adult Drinking Patterns Survey. The Young Persons Behavior and Attitudes Survey provides information on alcohol consumption in school aged children (11-16) in Northern Ireland. Continuous household survey In 2008/09, 74% of people in Northern Ireland reported that they drink alcohol (Males 79%, Females 70%). Between 1986 and 2008/09 the prevalence of drinking alcohol increased from 64% to 74% with a greater increased observed for females; Males from 72% to 79%; peaking at 81% in 2002/ /05; Females from 58% to 72%; peaking at 73% in 2002/03 (Figure 3, Appendix Table A). Around 6 out of 10 people report that they drink below sensible drinking levels (57%) compared to those who report drinking above sensible but below dangerous levels (12%) or at dangerous levels (4%) (Figure 4, Appendix Table B). Around half (48%) reported that they drank less nowadays compared to 5 years ago, while 13% reported that they drink more nowadays. 5

9 Adult drinking patterns in Northern Ireland key findings 8 Alcohol consumption More than seven in ten (72%) adults drink alcohol; males (74%), females (70%). Younger adults are more likely to drink than older adults, (83% years, 54% years. Prevalence is highest in the Eastern HSSB (78%), followed by the WHSSB (72%), the NHSSB (69%) and SHSSB (67%). The likelihood of drinking increases with socio-economic group, household income and education achievement. Frequency of drinking Over six in ten (62%) drinkers report drinking alcohol at least once a week 8% of drinkers report drinking alcohol either everyday or almost every day; males (11%), females (6%). Those aged 45 years or over are more likely to drink alcohol on most days. Days when drinking occurs Most drinking occurs over the weekend and peaks on Saturdays. Males are more likely than females to drink during the week. Younger adults (18-29 years) are more likely to drink at the weekend and less likely to drink during the week compared to those in the oldest age group (60-75 years). Drinks consumed The most common drink consumed is wine (50%), closely followed by beer (48%); o Males - beer (73%), wine (37%), spirits (24%) o Females - wine (64%), spirits (31%), beer (22%) o Younger (18-29 years) - beer (58%), wine (31%), spirits (27%), alcopops (26%). o Older (60-75 years) - wine (54%), beer (39%), spirits (34%). Where and with whom people drink Just under two thirds (64%) had consumed alcohol at home (64%), in the pub (24%) or in someone else s home (20%) and nearly one quarter had consumed alcohol in the pub (24%). Younger adults (18-29 years) are more likely than those in older age groups to drink in a pub, in someone else s home, nightclub/disco or outdoors. Males are more likely to drink in pubs (30% vs 17%) and less likely to drink in restaurants (13% vs 21%) compared to females. Males are more likely to drink alone (27% vs 14%) and less likely to drink with family (20% vs 28%) compared to females. Amount of alcohol consumed More than four in five (81%) respondents had exceeded the recommended daily limits # ; males (79%) and females (83%). Recommended daily limits are exceeded most often on a Saturday and then on a Friday. Nearly one quarter (24%) of respondents exceeded weekly sensible levels + ; (26%) males, (22%) females. Younger drinkers (18-29 years) are more likely than older drinkers (60-75 years) to exceed the weekly guidelines for sensible drinking limits. 6

10 Binge drinking ^ Nearly a third (32%) of those who drank in the week before the survey had engaged in at least one binge drinking session; males (35%), females (29%). Over half (54%) of respondents in the youngest age group (18-29) who drank in the week prior to the survey binge drank compared to 16% of respondents in the oldest age group (60-75). For those who drank in the week prior to the survey, Saturday is when just over seven in ten (72%) respondents consumed alcohol and one in five (20%) respondents engaged in at least one binge drinking session. Problem drinking CAGE question analysis (clinical interview questions) indicated that one in ten (10%) of those who drank in the week prior to the survey are highly likely to have a problem with alcohol. 8 # The current recommended daily drinking limits state that drinking four or more units of alcohol a day for males and three or more units a day for females, increases alcohol related health risks. + Levels of alcohol consumption can be banded into weekly guidelines for sensible drinking. On a weekly basis, males drinking 21 units or less are considered to be within sensible limits, those drinking between 22 and 50 units are considered to be above sensible but below dangerous levels and those drinking 51 units and above are drinking at dangerous levels. The sensible limit for females is 14 units per week, the above sensible and below dangerous level is between 15 and 35 units and dangerous levels are 36 units and above. ^There are various definitions of binge drinking. In this study a binge is defined as consuming 10 or more units of alcohol in one session for males and seven or more units of alcohol for females. Young persons behavior and attitudes survey (YPBAS) 9,10,11 Key findings from 2007; Over half (55%) of pupils reported every having drunk alcohol, with no significant difference in lifetime prevalence between boys (55%) and girls (56%). Lifetime prevalence of alcohol was significantly higher in the SEELB area (59%), compared with other Education and Library Board areas (BELB, 53%; WELB, 57%; NEELB, 57%; and SELB, 48%). Among pupils who have ever drunk alcohol, over half (55%) reported being drunk on at least one occasion. Girls (58%) were more likely to report ever being drunk than boys (51%). The average age at which pupils first drank alcohol was 12.0 yrs, with boys (11.7 yrs) significantly younger when they first drank alcohol compared to girls (12.3 yrs). Over one quarter (27%) of pupils who have ever drunk alcohol, have bought alcohol themselves, with buying alcohol more likely to be reported by girls (31%) than boys (24%). Between 2003 and 2007 (significant at 5% level) The proportion of pupils ever having an alcoholic drink decreased from 59.9% to 55.1%; for boys (from 60.8% to 55.3%) and girls (from 59.1% to 55.5%). Among pupils who have ever drunk alcohol, there was no significant change in the proportions who reported ever being drunk (55.2% in 2003 compared to 54.5% in 2007). Results from the YPBAS are available at 7

11 Percentage (%) Percentage (%) Percentage (%) Figure 5: Percentage of young people reporting ever having drunk alcohol by gender, HSBC* 2000 YPBAS 2003 YPBAS 2007 YPBAS Boys Girls All *In 1997 the Health Behaviour of School Children survey (HBSC) asked Have you ever tasted an alcoholic drink? while the 2000 and 2003 YPBAS surveys reworded this question to Have you ever taken an alcoholic drink (not just a taste or sip)? and thus the % obtained in 1997 are higher overall. Figure 6: Percentage of young people reporting ever having drunk alcohol by age, or under or older All Figure 7: Percentage of young people who report ever having been drunk by gender, HSBC* 2000 YPBAS 2003 YPBAS 2007 YPBAS* Boys Girls All * significant difference 8

12 Table 3: Number of times young people have been drunk (for those who had ever drunk alcohol) 1997 % 2000 % 2003 % 2007 % Never been drunk Yes, once Yes, 2-3 times Yes, 4-10 times Yes, more than 10 times Base Table 4: Source of most recent alcoholic drink I bought it myself from an off licence I bought it myself in a pub I bought it myself in a club/disco I got it myself at a party/wedding etc * * 9 9 Friends bought it for me/gave it to me My mother/father offered/gave it to me My brother/sister offered/gave it to me Another relative offered/gave it to me * * 8 6 Someone else bought it for me/gave it to me * * * 14 I took it without permission * * 9 6 Other Base * Option not available in these years possibly included in other category Table 5: Top five reasons young people give for drinking for each survey year 1997* % % % First To celebrate 79 To celebrate 86 I like the taste 85 Second I like the taste 74 I like the taste 83 To celebrate 82 Third To find out what it s like 69 To find out what it s like/ 60 To find out what it s like 63 to relax/ cheers me up Fourth Cheers me up 52 To get drunk 52 To feel relaxed 58 Fifth To feel relaxed 49 To be sociable 46 Cheers me up 55 * including those who have had just a taste or sip of alcohol In 1997 and 2000, the most common reason young people reported for drinking alcohol was to celebrate (79% and 86% respectively). Worth noting is the percentage change in those who say they like the taste. In 1997, 74% said they drank because they like the taste, but by 2003 this has risen to 85% and become the most commonly reported reason for drinking. This may be in part due to increasing popularity of alcopops, especially with young people (Table 5). Young people identified as regular drinkers (drinking once a month or more often) are more likely (p<0.001) than occasional/non drinkers to be involved in other risk taking behavior. They are more likely to be: be current smokers (38% vs 5%) have ever tried smoking (72% vs 20%) ever tried drugs (52% vs 8%) ever tried solvents (25% vs 5%) ever had sexual intercourse (31% vs 4%) 9

13 Alcohol pricing and expenditure In spite of extensive evidence that raising alcohol prices reduces consumption on a societal level, the trend is that the real price of alcoholic beverages and the real value of alcohol taxation are decreasing across the EU. 12 Price Alcohol was 66% more affordable in 2009 than in Off trade alcohol has become much more affordable than on trade alcohol since Beer sold off trade is 155% more affordable in 2009 than it was in Beer sold on trade is 39% more affordable than it was in Expenditure on alcohol Household purchases of alcoholic drinks rose by 5.5% in 2009 but are 2% lower than in This rise in 2009 reverses a previous fall in Spend on alcoholic drinks rose by 10.2% (Chapter 1: page 6). 14 Table 6: UK expenditure on alcoholic drink at constant 2009 prices Alcoholic drink per person per week % change since 2008 % change since 2006 Household Eaten out All alcoholic drinks % of alcoholic drinks eaten out

14 A comparison of spending between UK countries (Figure10) found that overall alcohol spending was highest in Scotland at 6.24 a week per person. Northern Ireland had the highest level of spending on alcoholic drinks consumed outside the house at 3.41 per person per week and the lowest spending on household supplies at In Northern Ireland the Expenditure and Food Survey (EFS) was renamed as the Living Costs and Food Survey (LCF) in 2008 when it became a module of the Integrated Household Survey (IHS). Table 7: Alcohol spending in Northern Ireland (pounds sterling per household per week), 2001/ Alcoholic beverages brought home Alcoholic beverages consumed away from home Total weekly household expenditure 2001/ / / / / Percentage of total expenditure (%) Alcoholic beverages brought home Alcoholic beverages consumed away from home The expenditure figures are rounded to the nearest 10p. Source: Living Costs and Food Survey

15 Alcohol related mortality in the United Kingdom In July 2006 the Office for National Statistics, General Register Office for Scotland and the Northern Ireland Statistics and Research Agency agreed on a harmonised definition of alcohol related deaths (See Appendix for ICD codes). 15 The current UK definition reports on the underlying cause of death, i.e. the disease or injury which initiated the chain of morbid events leading directly to death. This definition is generally used for reporting high level trends in mortality data for national and international statistics. However, it does not include deaths where an alcohol-related condition was recorded as a contributory factor but was not selected as the underlying cause. A study from the Centre for Public Health, Queen's University Belfast assessed whether alcohol-related mortality data in the UK should be extended to include contributory as well as underlying cause of death. A total of 101,320 deaths registered in Northern Ireland between 2001 and 2007 were analysed to determine the quantity and characteristics of those with an underlying or contributory alcohol-related cause of death. Alcohol was found to be an underlying cause of death in 1690 cases (1.7% of deaths) and a contributory cause in a further 1105 cases. Analyses show that the addition of alcoholrelated contributory causes of deaths would increase the male-female ratio, result in steeper socio-economic gradients and amplify the apparent rate of increase of alcoholrelated deaths. The significant contribution of alcohol to external causes of death, such as accidents and suicide, is also more evident. The authors concluded that using only underlying cause of death underestimates the burden of alcohol-related harm and may provide an inaccurate picture of those most likely to suffer from an alcohol-related death, especially among younger men. 16 The figures presented in this brief on alcohol related deaths are calculated on the basis of the agreed UK definition. In 2009: There were 8,664 alcohol related deaths in the UK (12.8 per 100,000), 367 fewer than the number recorded in 2008 (9,031 a rate of 13.6 per 100,000). Males accounted for approximately two-thirds of the total number of alcohol related deaths; 5,690 deaths (17.4 per 100,000 population) in males and 2,974 (8.4 per 100,000) in females. There were fewest alcohol-related deaths among people aged under 35; rates for those aged were 2.6 per 100,000 for males and 1.5 per 100,000 for females. The number of alcohol-related deaths in the UK increased over the last 10 years, rising from 6,884 (11.2 per 100,000 population) in 2000 to a point of 9,031 (13.6 per 100,000) in 2008 (Appendix Table C). Across the period, rates were highest among men and women aged In 2009 the rates for these groups were 41.8 and 20.1 per 100,000 population respectively

16 Number Alcohol related mortality in Northern Ireland 17 In 2010 there were 284 alcohol related deaths registered in Northern Ireland, 191 male and 93 female. The number of alcohol related deaths is higher in males than females; in 2009 there were almost twice as many alcohol related deaths registered for males (n=187; 21.3 per 100,000) compared to females (n=96; 10.5 per 100,000). Between 1999 and 2010 the number of alcohol related deaths has generally increased. The annual average number of alcohol related deaths registered between 1999 and 2001 was 190, this compares to an annual average of 281 alcohol related deaths registered between 2008 and 2010, a 48 per cent increase (Table 8). Table 8: Number and rate (crude) of alcohol related deaths registered in Northern Ireland P Registration year Number Crude rate per 100,000 population All Male Female All Male Female P P Figures are provisional until publication of the 2010 Annual Report of the Registrar General Figure 11: Number of alcohol related deaths in Northern Ireland by age, Under and over Between 1999 and 2009 there were a total of 2613 alcohol related deaths; 31% were to persons aged 45 to 54 and a further 26% of alcohol related deaths were to persons in the 55 to 64 age group (Table 8, Figure 11). Just five alcohol related deaths were to persons aged under 25 while 166 deaths were to those aged 75 and over. 13

17 Number Figure 12: Number of alcohol related deaths by age and registration year, Under and over For alcohol related deaths, the median age at death for 1999 to 2009 was 54 years; this is significantly below the median age at death, 78 years, for all deaths registered between 1999 and 2009 (Appendix Tables D and E). This shows the additional potential years of life lost due to alcohol related mortality, with 24 years of potential life lost for each alcohol related death. Alcohol related deaths by underlying cause Between 2001 and 2009: o 70% of alcohol related deaths were other alcohol related deaths such as alcoholic liver disease. o Mental and behavioural disorders due to alcohol use accounted for 27% of alcohol related deaths, o Accidental poisoning accounted for 3% of alcohol related deaths. Over the period there were just two deaths due to Intentional self-poisoning by and exposure to alcohol or poisoning by and exposure to alcohol, undetermined intent. 14

18 Banbridge Magherafelt Omagh Armagh Limavady Fermanagh Craigavon Dungannon Moyle Lisburn Ballymena Coleraine Larne Antri, Strabane Newtownabbey Down Newry and Mourne Castlereagh Carrickfergus Northern Ireland Cookstown North Down Ballymoney Ards Derry Belfast Deaths per 100,000 Alcohol related mortality by Health and Social Care Trust / Local Commissioning Group and Local Government District In 2009, the highest rate of alcohol related deaths (crude rate per 100,000) was recorded for the Belfast Trust/LCG (22.4), followed by the Western Trust/LCG (18.1), the South Eastern Trust/LCG (16.3), the Northern Trust/LCG (12.7) and the Southern Trust/LCG (11.3) (Figure 13, Appendix Tables F and G). Figure 13: Alcohol related death rate (crude per 100,000) by Health and Social Care Trust / Local Commissioning Group Belfast Northern South Eastern Southern Western NI Using combined data for , the highest rates of alcohol related deaths (crude rate per 100,000) were recorded for Belfast LGD (26.4), Derry LGD (21.0), Ards LGD (16.4), Ballymoney LGD (16.2) and North Down LGD (15.5) (Figure14, Appendix Table H). Figure 14: Alcohol related death rate (crude per 100,000) by Local Government District, combined years

19 Alcohol related mortality and inequality The Health and Social Care Inequalities Monitoring System (HSCIMS) monitors a number of indicators, including alcohol related deaths, over time to assess area differences. Inequalities between the 20% most deprived areas (NISRA 2005 NI Multiple Deprivation Measure) and NI as a whole are measured. Results for the most rural areas are also compared against Northern Ireland overall. Figure 15 shows the average five year alcohol related rate for the 20% most deprived areas compared to the Northern Ireland average. Data for five years have been aggregated in order to provide robust results. The alcohol related death rate rose by around 10% between 2005 and 2008 (p) in both deprived areas and Northern Ireland generally. Between 2005 and 2008 the overall NI alcohol related death rate rose by around 10% from 12.9 to 14.2 deaths per 100,000 (Figure 15). The deprived death rate has remained large at around 120% higher than the NI rate. 18 The alcohol related death rate increased in rural areas by 13% from 6.9 to 7.8 deaths per 100,000 population between 2005 and 2008(p). In comparison, alcohol related mortality in NI increased from 12.9 to 14.2 deaths per 100,000 population (an increase of 10%) over the same period. The rural inequality gap remained fairly steady and stood at 45% in 2008(p) (Figure 16). 18 Note: Standardised Death Rate due to alcohol related causes - This is calculated by standardizing (using the direct method) the average death rate in Northern Ireland (over a five year period) due to alcohol related causes to the 2001 Census. 16

20 Alcohol related death rate per 100,000 population Figure 18 shows the rate for the total number of alcohol related deaths for the years Those living in the most deprived communities are around four times more likely to die from alcohol related mortality than those who live in the least deprived areas. 17 Figure 18: Alcohol related death rate per 100,000 population by deprivation quintile, Least deprived Most deprived Alcohol related mortality by Health and Social Care Trust In 2010, the first subregional report of the HSCIMS was published 19 The report concentrates on the health inequalities that exist at Health and Social Care Trust area level (and also Local Commissioning Groups as their geographical boundaries are coterminous with Trust boundaries). Health outcomes for the 20% most deprived areas (according to the NIMDM) within a Trust are compared with those for the Trust itself. Changes in inequalities gaps are monitored over time. The 20% most deprived areas within each Trust should not be confused with those identified in the regional analyses. The 2005 NISRA Multiple Deprivation Measure was used to rank the Super Output Areas (SOAs) within each Trust area from most deprived to least deprived. The 20% most deprived areas within the Trust were then identified. Therefore in each Trust, some of the areas that are classified as the most deprived would not be included in the most deprived at the Northern Ireland area level. Figure 19: Belfast Trust Over the period the increase in alcohol related mortality within the Belfast Trust and its most deprived areas (2% and 3% respectively) grew at a slower rate than in NI overall (10% increase). Despite this, the alcohol related death rate in Belfast Trust was still 69% higher than in NI in The SDR in deprived areas was consistently double that in the overall Trust across the period. 17

21 Figure 20: Northern Trust Alcohol related mortality increased over the period across all areas. The alcohol related death rate within the Northern Trust grew by 19% over the period. This compared with rises of 10% and 11% respectively in the regional and most deprived Trust area death rate. The Trust inequality gap fell from 88% in 2005 to 76% in Figure 21: South Eastern Trust Alcohol related mortality increased slightly over the period within all areas. The overall Trust death rate was similar to that in the wider region. The death rate in the most deprived South Eastern Trust areas remained virtually double that in the overall Trust. Figure 22: Southern Trust The alcohol related death rate in the overall Southern Trust was continually lower than that in the wider region. While alcohol related mortality increased for all areas over the period, it rose slightly faster in the most deprived areas in the Southern Trust. The Trust inequality gap therefore rose from 87% in 2005 to 94% in

22 Figure 23: Western Trust Alcohol related mortality rates increased across all areas. The alcohol related death rate in the overall Western Trust was broadly similar to that in the wider region. The rate in the most deprived Western Trust areas remained more than double that in the overall Trust throughout the period (the Trust inequality gap was 112% in both 2005 and 2008). A recent study examined differences in alcohol related mortality risk between areas in Northern Ireland, adjusting for the characteristics of the individuals living within these areas. The study using data from the Northern Ireland Mortality study, identified 578 alcohol related deaths in people aged Findings showed an increased risk of alcohol-related mortality among disadvantaged individuals, and divorced, widowed and separated males. The risk of an alcohol-related death was significantly higher in deprived areas for both males [hazard ratio (HR) 3.70; 95% confidence interval (CI) 2.65, 5.18] and females (HR 2.67 (95% CI.72,4.15); however, once adjustment was made for the characteristics of the individuals living within areas, the excess risk for more deprived areas disappeared. Both males and females in rural areas had a reduced risk of an alcohol-related death compared to their counterparts in urban areas; these differences remained after adjustment for the composition of the people within these areas. The authors concluded that alcohol-related mortality is higher in more deprived, compared to more affluent areas; however, this appears to be due to characteristics of individuals within deprived areas, rather than to some independent effect of area deprivation per se. Risk of alcohol-related mortality is lower in rural than urban areas, but the cause is unknown

23 Alcohol mortality and life expectancy The effect upon life expectancy of additional broader mortality definitions, namely amenable mortality (deaths that should not occur in the presence of good healthcare), smoking related deaths and alcohol related deaths were studied for Northern Ireland overall and its most deprived areas. 21 A reduction in amenable mortality between and contributed to improving life expectancy in both the most deprived areas and the wider region by around half a year for both genders. However, amenable mortality remained higher in deprived areas than in Northern Ireland overall and accounted for about one-fifth of both the male and female deprivation gaps in (0.9 years and 0.6 years respectively). Alcohol related deaths had relatively little impact on the overall change in life expectancy for both males and females in Northern Ireland and its most deprived areas between and Relatively higher alcohol related mortality in the most deprived areas than regionally did however contribute 0.6 years to the male deprivation gap and 0.2 years to the female gap in

24 Number of admissions Hospital admissions for alcohol related harm In 2009/10 there were 3,475 admissions to acute hospitals in Northern Ireland with a primary alcohol related diagnosis. The rate of admissions is higher for males compared to females (2.5 times). In 2009/10 there were 2,523 male (250 per 100,000) and 952 female (105 per 100,000) admissions with a primary alcohol related diagnosis. Between 2000/01 and 2009/10 the number of alcohol related admissions has increased with greater increases among females compared to males: admissions with a primary alcohol related diagnosis have increased by 54%, (females 68%, males 49%). admissions with any alcohol related diagnosis have increased by 61%, (females 68%, males 58%) (Table 9, Figure 25). Table 9: Admissions* to HSC Hospitals with an alcohol related diagnosis^ from 1999/2000 to 2009/2010 Primary alcohol related diagnosis Any alcohol related diagnosis Male Female All Male Female All 1999/ / / / / / / / / / / Figure 25: Admissions* to HSC hospitals with an alcohol related diagnosis^ in the primary diagnosis field, from 1999/2000 to 2009/2010 4,000 3,500 3,000 2,500 2,000 1,500 Male Female All 1, / / / / / / / / / / /10 21

25 Crude rate of admissions per 100,000 Crude rate per 100,000 population Variation by age In the highest rates of admissions with a primary alcohol related diagnosis were among: males aged years (n=470, 765 per 100,000), years (n=345, 633 per 100,000) and years (n=401, 626 per 100,000) females aged years (n=139, 249 per 100,000), years (n=154, 240 per 100,000) and years (n=122, 183 per 100,000) (Figure 26, Appendix Tables I and J). Figure 26: Admissions* to HSC hospitals with an alcohol related diagnosis^ in the primary diagnosis field, from 1999/2000 to 2009/2010, by 5 year age band (five year annualised average, crude rate per 100,000) Male: 2000/ /05 Male: 2005/ /10 Female: 2000/ /05 Female: 2005/ / Total *1 Deaths and discharges are used to denote admissions; this figure should not be used to denote individuals as a person may be admitted to hospital more than once in a year or across a number of years ^ ICD-10 codes used to identify alcohol related admissions are listed in Appendix While the rate of hospital admissions for males is higher than for females, among those aged 0-19 the rate of admissions with a primary alcohol related diagnosis is similar for males (34 per 100,000) and females (40 per 100,000) (Figure 27). Figure 27: Admissions* to HSC hospitals with an alcohol related diagnosis from to 2009/10 for those aged 0-19 by gender Male - primary diagnosis Female - primary diagnosis Male - any diagnosis Female - any diagnosis / / / / / / / / / / /10 22

26 Crude rate of admissions (per 100,000) Crude rate of admissions (per 100,000) Variation by diagnosis Between 1999/00 and 2009/10 the rate of admissions* (any diagnosis) for: mental or behavioural disorders due to alcohol (F10) have increased by 53%, from 255 to 398 per 100,000; males 402 to 600 per 100,000 and females from per 100,000. alcoholic liver disease (K70) has increased by 89%, from 34 to 63 per 100,000; males 60 to 82 per 100,000, and females from 17 to 45 per 100,000) (Table10, Appendix Tables K, L and M). Table 10: Rates and percentage increase in admissions* for Mental or behavioural disorders due to alcohol and alcoholic liver disease for 1999/00 and 2009/10 by gender. F10 K70 Primary diagnosis Any diagnosis Primary diagnosis Any diagnosis Male Female All 1999/ / / / / /10 Rate per 100, % increase Rate per 100, % increase Rate per 100, % increase Rate per 100, % increase Figure 28: Admissions to HSC hospitals with a mental or behavioural disorder due to alcohol by gender, 1999/2000 to 2009/ Male - F10 (primary diagnosis) Female - F10 (primary diagnosis) Male - F10 (any diagnosis) Female - F10 (any diagnosis) / / / / / / / / / / /10 Figure 29: Admissions to HSC hospitals with alcoholic liver disease by gender, 1999/2000 to 2009/ Male - K70 (primary diagnosis) Female - K70 (primary diagnosis) Male - K70 (any diagnosis) Female - K70 (any diagnosis) 1999/ / / / / / / / / / /10 23

27 Percentage (%) Treatment for alcohol misuse in Northern Ireland The Census of drug and Alcohol treatment services in Northern Ireland provides information on the number of persons in treatment drug and /or alcohol misuse. The third Census was conducted on 1 st March 2010; the first Census was conducted on 1st March 2005, and a follow up Census was conducted on 1st March It should be noted that a census represents a snap-shot at a particular point in time, in this case the numbers in treatment on 1st March As individuals can be in contact with more than one service, there may be an element of double-counting. These figures cannot be used to derive numbers in treatment over the course of a year. Figure 30: Individuals in treatment by Health and Social Care Trust area, 1st March Belfast Northern South Eastern Southern Western Alcohol only Drugs and alcohol Of the 5846 individuals in treatment on 1st March 2010; 3328 (57%) were in treatment for alcohol misuse (2296 male, 1032 female); the majority were aged 18 and over (3009, 90%) 1224 (21%) were in treatment for both drug and alcohol misuse (963 male, 261 female); the majority were aged 18 and over (1070, 87%) Across the five Health and Social Care Trusts the largest proportion of individuals in treatment for alcohol misuse was in the Southern HSCT (69%), followed by the South Eastern (62%), Western (61%), Northern (56%) and Belfast HSCT (45%) (Figure 30). 22 Drug misuse database (DMD) The DMD collates information on individuals presenting to services with problem drug use. While alcohol cannot be recorded as the main problem drug or as one of the four subsidiary drugs, clients can still record problem alcohol use, the average units consumed per week in the last 4 weeks and whether or not alcohol is their main problem. In 2009/10, 34% of clients who presented for treatment also reported problem alcohol use (Table 11). The largest proportions of clients who reported problem alcohol use were in the Western (55%) HSCT followed by the Southern (44%), Belfast (35%), South Eastern (26%) and Northern (25%). Almost three fifths (58%) of those that presented to treatment for both drug and alcohol misuse reported alcohol to be their main problem. Of those who reported problem alcohol use, almost one half (46%) reported that they consumed between 1 and 99 units of alcohol on average per week in the four weeks before treatment. One quarter (25%) reported that they consumed between 100 and 249 units

28 Table 11: Individuals presenting to services with problem alcohol use 2005/ / / / /10 n % n % n % n % n % Individuals presenting to services Problem alcohol use Alcohol use as main problem Further information on the Census of drug and Alcohol treatment services or the DMD may be found at Road traffic accidents The Police Service of Northern Ireland collate all statistics in relation to road traffic accidents. Annual reports are available at In 2009/10, there were 582 casualties with alcohol or drugs as the principle cause (23 deaths, 120 seriously injured and 439 slightly injured) The most common causes of fatal and serious injury road traffic collisions in 2009/10 were excessive speed having regard to conditions (158 collisions), alcohol or drugs (all road users) (112 collisions) and inattention or attention diverted (81 collisions). 25