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 2009. 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).
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 45-54 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 2005-2009, 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 2006-08. 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 116-186 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).
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 2008 - 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 15 16 - 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
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; www.who.int/substance_abuse/publications/global_alcohol_report/msbgsruprofiles.pdf www.who.int/substance_abuse/publications/global_alcohol_report/en/ 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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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 2007. 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 52 63 56 67 62 6 15 11 13 15 42 33 31 30 33 23 18 16 14 18 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 21.5 15 39.3 16.5 17.4 Females 9.3 7.2 15.8 8.1 8.1 Sources: DHSSPS Adult Drinking Patterns Survey and ONS General Lifestyle Survey 3
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 0.3 0.3 GP/pactice nurse consultations attributable to alcohol 9.3 10.4 Laboratory testing in primary care 0.1 0.1 Hospitalisation days acute 65.5 65.5 Hospitalisation days mental illness 8.6 9.5 A&E attendances 16.6 18.4 Outpatient hospital visits 5.2 5.8 Day hospital visits mental illness <0.1 <0.1 Day hospital visits non-mental illness 1.9 1.9 Community psychiatric teams 4.2 4.7 Health promotion 0.4 0.4 Drug and alcohol coordination teams 3.5 3.5 Ambulance journeys 6.5 7.2 Total estimated cost to healthcare 122.2 127.8 Children and family services 36.9 41.0 Youth justice 3.6 3.6 Criminal justice social work 8.0 8.0 Total estimated cost to social work 48.5 52.6 Fire service callouts 0.4 0.4 Policing for alcohol related crime 0.7 0.7 Policing for violent crime partly related to alcohol 89.7 99.7 Policing for other crime partly related to alcohol 132.8 147.5 Total estimated cost to fire and police services 223.6 248.3 Court costs for violent crime related to alcohol 2.5 2.8 Court costs for other crime related to alcohol 16.6 17.8 Public prosecution violent crime related to alcohol 1.4 1.6 Public prosecution costs for other crime related to alcohol 9.4 10.4 Legal Aid costs for violent crime related to alcohol 1.4 1.6 Legal Aid costs for other crime related to alcohol 9.1 10.1 Prison costs for violent crime related to alcohol 33.7 37.4 Prison costs for other crime related to alcohol 9.7 10.8 Total estimated cost to courts and prisons 83.8 92.5 Presenteeism at work 77.5 86.1 Absenteeism from work 33.1 33.1 Unemployment 50.0 55.6 Premature mortality among people of working age 41.1 41.1 Total estimated cost to wider economy 201.7 215.9 Total estimated cost 679.8 737.1 4
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 http://www.csu.nisra.gov.uk/survey.asp141.htm 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 2002/03-2004/05; 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
Adult drinking patterns in Northern Ireland 2008 - 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% 18-29 years, 54% 60-75 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
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 www.csu.nisra.gov.uk/survey.asp96.htm. 7
Percentage (%) Percentage (%) Percentage (%) Figure 5: Percentage of young people reporting ever having drunk alcohol by gender, 1997-2007 90 80 70 60 50 40 30 20 10 0 82 76 79 60 61 59 54 57 60 55 56 55 1997 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, 2000-2007 90 80 70 60 50 40 30 20 10 0 83 81 81 73 75 69 59 59 60 57 59 55 44 47 44 29 25 28 12 or under 13 14 15 16 or older All 2000 2003 2007 Figure 7: Percentage of young people who report ever having been drunk by gender, 1997-2007 70 60 50 40 30 20 10 0 61 62 61 56 54 56 51 57 56 58 55 51 1997 HSBC* 2000 YPBAS 2003 YPBAS 2007 YPBAS* Boys Girls All * significant difference 8
Table 3: Number of times young people have been drunk (for those who had ever drunk alcohol) 1997 % 2000 % 2003 % 2007 % Never been drunk 46 39 45 46 Yes, once 16 17 18 20 Yes, 2-3 times 13 17 16 14 Yes, 4-10 times 10 10 9 8 Yes, more than 10 times 15 17 13 12 Base 4313 3447 4078 1788 Table 4: Source of most recent alcoholic drink 1997 2000 2003 2007 I bought it myself from an off licence 11 16 9 6 I bought it myself in a pub 8 8 5 3 I bought it myself in a club/disco 14 11 5 6 I got it myself at a party/wedding etc * * 9 9 Friends bought it for me/gave it to me 32 37 32 20 My mother/father offered/gave it to me 21 13 15 17 My brother/sister offered/gave it to me 8 5 5 4 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 7 10 4 9 Base 3300 2830 3926 1626 * 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* 2000 2003 % % % 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
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 1987. Off trade alcohol has become much more affordable than on trade alcohol since 1987. Beer sold off trade is 155% more affordable in 2009 than it was in 1987. Beer sold on trade is 39% more affordable than it was in 1987. 13 Expenditure on alcohol Household purchases of alcoholic drinks rose by 5.5% in 2009 but are 2% lower than in 2006. This rise in 2009 reverses a previous fall in 2008. 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 2006 2007 2008 2009 % change since 2008 % change since 2006 Household 2.95 2.91 2.61 2.89 10.8-2.0 Eaten out 3.82 3.52 3.02 3.08 1.8-19.5 All alcoholic drinks 6.77 6.43 5.63 5.96 6.0-11.9 % of alcoholic drinks eaten out 56 55 54 52 10
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 2.42. 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), 2001/02-2009 Alcoholic beverages brought home Alcoholic beverages consumed away from home Total weekly household expenditure 2001/02 2002/03 2003/04 2004/05 2005/06 2006 2007 2008 2009 4.7 5.3 5.2 4.6 5.5 5.5 5.8 6.0 6.7 8.4 8.2 8.4 7.6 9.2 8.0 8.7 7.0 8.4 379.4 372.3 407.3 377.8 420.6 439.3 468.5 491.1 471.2 Percentage of total expenditure (%) Alcoholic beverages brought home 1.25 1.42 1.28 1.23 1.30 1.26 1.25 1.22 1.42 Alcoholic beverages consumed away from home The expenditure figures are rounded to the nearest 10p. Source: Living Costs and Food Survey 2.22 2.20 2.07 2.02 2.18 1.82 1.86 1.43 1.78 11
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 15 34 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 2000 09 period, rates were highest among men and women aged 55 74. In 2009 the rates for these groups were 41.8 and 20.1 per 100,000 population respectively. 15 12
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 1999-2010 P Registration year Number Crude rate per 100,000 population All Male Female All Male Female 1999 174 116 58 10.4 14.2 6.7 2000 190 134 56 11.3 16.3 6.5 2001 206 131 75 12.2 15.9 8.7 2002 238 165 73 14.0 19.9 8.4 2003 214 132 82 12.6 15.8 9.4 2004 255 174 81 14.9 20.8 9.3 2005 246 171 75 14.3 20.3 8.5 2006 248 173 75 14.2 20.3 8.4 2007 283 199 84 16.1 23.1 9.4 2008 276 185 91 15.5 21.2 10.1 2009 283 187 96 15.8 21.3 10.5 2010 P 284 191 93 - - - 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, 1999-2009 900 800 700 600 500 400 300 200 100 0 5 99 477 821 675 370 166 Under 25 25-34 35-44 45-54 55-64 65-74 75 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
Number Figure 12: Number of alcohol related deaths by age and registration year, 1999-2009 110 100 90 80 70 60 50 40 30 20 10 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Under 25 25-34 35-44 45-54 55-64 65-74 75 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
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 30 25 20 15 10 Belfast Northern South Eastern Southern Western NI 5 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 Using combined data for 2005-2009, 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 2005-2009 30 25 20 15 10 5 0 15
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
Alcohol related death rate per 100,000 population Figure 18 shows the rate for the total number of alcohol related deaths for the years 2003-2009. 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, 2003-2009 250 218 200 150 120 100 50 52 58 77 0 Least deprived Most deprived Alcohol related mortality by Health and Social Care Trust In 2010, the first subregional report of the HSCIMS was published www.dhsspsni.gov.uk/subreg_inequalities_monitoring_1.pdf. 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 2008. The SDR in deprived areas was consistently double that in the overall Trust across the period. 17
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 2008. 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 2008. 18
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 25-74. 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. 20 19
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 2001-03 and 2006-08 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 2006-08 (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 2001-03 and 2006-08. 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 2006-08. 20
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 1999/00 1697 566 2263 5198 1969 7167 2000/01 1844 675 2519 6208 2424 8632 2001/02 1990 741 2731 6689 2713 9402 2002/03 2015 733 2748 6612 2749 9361 2003/04 1933 745 2678 6738 2655 9393 2004/05 2199 821 3020 7207 2973 10180 2005/06 2234 770 3004 7031 2921 9952 2006/07 2013 777 2790 7009 2817 9826 2007/08 2508 836 3344 8207 3174 11381 2008/09 2448 868 3316 8270 3257 11527 2009/10 2523 952 3475 8235 3308 11543 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 1,000 500 0 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 21
Crude rate of admissions per 100,000 Crude rate per 100,000 population Variation by age In 2009-10 the highest rates of admissions with a primary alcohol related diagnosis were among: males aged 45-49 years (n=470, 765 per 100,000), 50-54 years (n=345, 633 per 100,000) and 40-44 years (n=401, 626 per 100,000) females aged 50-54 years (n=139, 249 per 100,000), 45-49 years (n=154, 240 per 100,000) and 40-44 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) 800 700 600 500 400 300 200 Male: 2000/01-2004/05 Male: 2005/06-2009/10 Female: 2000/01-2004/05 Female: 2005/06-2009/10 100 0 0-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ 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 1999-2000 to 2009/10 for those aged 0-19 by gender 160 140 120 100 80 60 40 Male - primary diagnosis Female - primary diagnosis Male - any diagnosis Female - any diagnosis 20 0 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 22
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 116-186 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 1999/00 2009/10 1999/00 2009/10 1999/00 2009/10 Rate per 100,000 133 212 42 71 86 140 % increase 59 70 63 Rate per 100,000 402 600 116 186 255 389 % increase 49 60 53 Rate per 100,000 32 39 11 23 21 31 % increase 23 106 45 Rate per 100,000 60 82 17 45 34 63 % increase 61 169 89 Figure 28: Admissions to HSC hospitals with a mental or behavioural disorder due to alcohol by gender, 1999/2000 to 2009/2010. 700 600 500 400 300 200 Male - F10 (primary diagnosis) Female - F10 (primary diagnosis) Male - F10 (any diagnosis) Female - F10 (any diagnosis) 100 0 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 Figure 29: Admissions to HSC hospitals with alcoholic liver disease by gender, 1999/2000 to 2009/2010. 100 90 80 70 60 50 40 30 20 10 0 Male - K70 (primary diagnosis) Female - K70 (primary diagnosis) Male - K70 (any diagnosis) Female - K70 (any diagnosis) 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 23
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 2007. 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 2010. 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 2010 80 70 60 50 40 30 20 10 0 45 27 56 13 62 Belfast Northern South Eastern 69 18 18 61 22 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. 23 24
Table 11: Individuals presenting to services with problem alcohol use 2005/06 2006/07 2007/08 2008/09 2009/10 n % n % n % n % n % Individuals presenting to 1666 100 1464 100 1973 100 1754 100 2008 100 services Problem alcohol use 523 31 538 37 690 35 643 37 685 34 Alcohol use as main problem 244 15 295 20 362 18 318 18 398 20 Further information on the Census of drug and Alcohol treatment services or the DMD may be found at www.dhsspsni.gov.uk/index/stats_research/public_health/statistics_and_researchdrugs_alcohol-2.htm Road traffic accidents The Police Service of Northern Ireland collate all statistics in relation to road traffic accidents. Annual reports are available at www.psni.police.uk/index/updates/updates_statistics/updates_road_traffic_statistics.htm 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
APPENDIX Table A: Prevalence of Drinking by Sex and Age, 1986 to 2008-09 Persons aged 18+ Sex and Age 1986 1990-91 1994-95 1996-97 1998-99 2000-01 2002-03 2004-05 2006-07 2008-09 Percentages Base (2008-09) = 100% 1 All 18-24 71 77 80 82 83 82 88 86 88 87 225 25-44 77 81 83 83 83 84 85 88 84 82 1,103 45-64 57 67 71 71 71 70 76 75 77 77 1,040 65+ 45 51 49 54 51 47 54 52 53 52 742 All 64 71 72 73 73 72 76 76 75 74 3,110 Male 18-24 75 78 82 83 83 88 90 87 91 87 76 25-44 81 86 85 86 85 88 87 91 88 87 431 45-64 66 74 80 76 77 75 81 80 79 82 459 65+ 59 64 62 66 63 63 66 64 63 62 309 All 72 77 78 78 78 79 81 81 80 79 1,275 Female 18-24 67 76 78 80 83 79 86 85 86 87 149 25-44 73 78 81 82 82 81 84 86 81 79 672 45-64 50 61 64 66 66 66 72 71 75 73 581 65+ 34 41 40 45 43 37 45 42 46 46 433 All 58 65 67 69 69 67 73 72 72 70 1,835 Source: Continuous Household Survey Notes: 1 Bases for earlier years are of a similar size 26
Table B: Level of alcohol consumption by sex, 1986-2008/1010 Persons aged 18+ Sex and level of alcohol consumption Percentages 1986 1990-91 1992-93 1994-95 1996-97 1998-99 2000-01 2002-03 2004-05 2006-07 2008-09 All Non-Drinker 36 29 29 28 27 27 28 24 24 25 26 Below sensible levels 58 60 60 59 59 58 54 56 57 57 57 Above sensible, below dangerous 5 8 9 10 12 12 13 15 14 14 12 Dangerous levels 1 2 2 3 3 2 5 6 5 4 4 Base=100% (All Persons) 4,872 5,585 5,382 5,190 4,636 4,419 4,272 4,087 3,955 3,608 3,110 Male Non-Drinker 28 23 23 22 22 22 21 19 19 20 21 Below sensible levels 61 61 59 58 56 56 50 48 52 52 53 Above sensible, below dangerous 9 14 14 16 17 18 19 22 20 20 19 Dangerous levels 1 3 4 5 5 4 9 11 9 8 8 Base=100% (Males) 2,165 2,502 2,382 2,237 1,993 1,839 1,752 1,735 1,676 1,472 1,275 Female Non-Drinker 43 35 33 33 30 31 33 27 28 28 30 Below sensible levels 55 60 60 60 61 59 57 61 61 61 60 Above sensible, below dangerous 3 4 5 6 7 8 9 9 10 10 8 Dangerous levels <1 1 1 1 1 1 1 2 2 1 2 Base=100% (Females) 2,707 3,083 3,000 2,953 2,643 2,580 2,520 2,352 2,279 2,136 1,835 Source: Continuous Household Survey Notes: Recommended sensible levels used are 21 units of alcohol per week for men and 14 units per week for women. Maximum safe levels are 50 units per week for men and 35 units per week for women. 1 All alcohol consumption above sensible levels 27
Table C: Alcohol related deaths (underlying cause) (European Age Standardised Rate per 100,000) in the United Kingdom by gender, 2001-2009 UK England Wales Scotland M F All M F All M F All M F All N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate 2000 4483 15.2 2401 7.4 6884 11.2 3222 13.0 1817 6.6 5039 9.7 209 14.0 131 8.0 340 10.9 900 35.4 392 14.1 1292-2001 4938 16.5 2561 7.8 7499 12.0 3578 14.2 1901 6.9 5479 10.5 239 16.0 146 8.6 385 12.2 964 37.4 434 15.2 1398-2002 5069 16.8 2632 7.9 7701 12.2 3635 14.3 1957 7.0 5592 10.6 236 15.4 127 7.3 363 11.2 1023 39.6 464 16.1 1487-2003 5443 17.8 2721 8.1 8164 12.8 3968 15.5 2016 7.2 5984 11.3 269 17.2 143 8.1 412 12.5 1056 39.9 469 16.2 1525-2004 5431 17.6 2790 8.3 8221 12.8 3992 15.2 2114 7.5 6036 11.2 266 17.0 150 8.8 416 12.8 1037 38.9 441 15.1 1484-2005 5566 17.9 2820 8.3 8386 12.9 4103 15.7 2094 7.3 6197 11.4 254 15.9 152 8.9 406 12.3 1021 37.9 492 16.7 1513 26.8 2006 5768 18.4 2990 8.8 8758 13.4 4271 16.2 2246 7.8 6517 11.9 271 17.2 159 9.2 430 13.1 1040 38.5 506 17.2 1546 27.3 2007 5732 18.1 2992 8.7 8724 13.3 4234 15.9 2310 8.0 6544 11.9 326 20.4 151 8.6 477 14.4 959 35.2 440 14.8 1399 24.6 2008 5999 18.7 3032 8.7 9031 13.6 4476 16.7 2295 7.9 6771 12.2 344 21.4 197 11.0 541 16.1 971 35.0 440 14.7 1411 24.4 2009 5690 17.4 2974 8.4 8664 12.8 4315 15.8 2267 7.7 6582 11.6 334 20.3 159 8.8 493 14.4 837 30.0 445 14.4 1282 21.8 28
Table D: Number of alcohol related deaths by age and registration year, 1999-2009 Age group All ages <25 25-34 35-44 45-54 55-64 65-74 >75 Median age 1999 174-12 27 51 46 23 15 55 2000 190 1 10 39 46 54 27 13 55 2001 206-10 38 71 46 27 14 53 2002 238 1 5 52 65 60 35 20 54 2003 214-11 31 66 52 37 17 55 2004 255 1 9 55 72 72 32 14 54 2005 246-12 48 78 61 37 10 53 2006 248 1 6 43 83 61 35 19 54 2007 283 1 9 66 89 68 33 17 52 2008 276-6 34 102 75 48 11 55 2009 283-9 44 98 80 36 16 54 Table E: Crude rate (per 100,000) of alcohol related deaths by age and registration year, 1999-2009 Age group All <25 25-34 35-44 45-54 55-64 65-74 >75 1999 ages 10.4-4.8 11.4 26.0 29.5 18.8 15.3 2000 11.3 0.2 4.0 16.0 23.2 33.8 22.0 13.2 2001 12.2-4.1 15.3 35.3 28.2 21.9 13.9 2002 14.0 0.2 2.1 20.7 32.0 35.7 28.1 19.5 2003 12.6-4.7 12.2 32.0 30.2 29.4 16.3 2004 14.9 0.2 3.9 21.5 34.4 40.8 25.1 13.2 2005 14.3-5.3 18.6 36.4 33.8 28.8 9.3 2006 14.2 0.2 2.6 16.6 37.8 33.2 27.0 17.3 2007 16.1 0.2 3.9 25.5 39.6 36.5 25.0 15.2 2008 15.5-2.5 13.2 44.3 39.9 35.4 9.7 2009 15.8-3.8 17.3 41.5 42.3 25.8 13.9 29
Table F: Number of alcohol related deaths by Local Commissioning Group/Local Government District, 2001-2009 LCG/LGD 2001 2002 2003 2004 2005 2006 2007 2008 2009 Belfast LCG 75 88 71 70 83 69 89 86 75 Belfast 70 82 60 61 77 61 82 69 65 Castlereagh 5 6 11 9 6 8 7 17 10 Northern LCG 50 50 39 39 49 59 60 67 58 Antrim 4 4 5 4 4 7 10 6 7 Ballymena 5 6 7 3 4 8 9 7 10 Ballymoney 1 1 0 2 4 3 4 6 7 Carrickfergus 2 9 2 2 4 8 4 7 7 Coleraine 7 8 7 5 10 5 7 8 5 Cookstown 5 1 0 2 4 7 6 7 3 Larne 4 9 4 4 5 6 2 5 2 Magherafelt 3 2 2 2 5 3 6 3 3 Moyle 2 1 2 2 1 4 1 2 2 Newtownabbey 17 9 10 13 8 8 11 16 12 Southern LCG 29 24 33 41 39 29 43 38 40 Armagh 8 5 6 8 10 3 5 5 5 Banbridge 4 2 2 5 3 5 2 3 5 Craigavon 7 8 10 12 11 6 10 10 10 Dungannon 2 2 4 5 5 5 9 6 4 Newry and Mourne 8 7 11 11 10 10 17 14 16 South Eastern LCG 28 35 43 58 50 41 43 50 56 Ards 8 10 11 16 14 7 12 10 20 Down 4 6 7 8 11 10 7 11 8 Lisburn 5 11 11 21 12 11 15 16 15 North Down 11 8 14 13 13 13 9 13 13 Western LCG 24 41 28 47 25 50 48 35 54 Derry 6 17 16 13 13 27 25 18 31 Fermanagh 7 8 3 9 4 8 5 5 9 Limavady 1 3 0 8 4 3 4 3 3 Omagh 4 11 6 8 3 4 6 6 5 Strabane 6 2 3 9 1 8 8 3 6 Total 206 238 214 255 246 248 283 276 283 30
Table G: Crude rate (per 100,000) of alcohol related deaths by Local Commissioning Group/Local Government District, 2001-2009 LCG/LGD 2001 2002 2003 2004 2005 2006 2007 2008 2009 Belfast LCG 21.8 25.8 21.0 20.9 24.9 20.7 26.7 25.7 22.4 Belfast 29.9 22.1 22.7 28.7 22.8 30.7 25.7 24.2 29.9 Castlereagh 9.0 16.6 13.7 9.1 12.2 10.7 25.7 15.0 9.0 Northern LCG 11.7 11.6 9.0 8.9 11.1 13.3 13.3 14.8 12.7 Antrim 8.2 8.2 10.2 8.0 7.9 13.6 19.0 11.3 13.0 Ballymena 10.2 11.8 5.0 6.6 13.0 14.5 11.2 15.8 10.2 Ballymoney 3.6 0.0 7.1 13.9 10.3 13.4 19.9 23.0 3.6 Carrickfergus 23.6 5.2 5.2 10.2 20.1 10.0 17.5 17.4 23.6 Coleraine 14.2 12.5 8.8 17.7 8.8 12.3 14.0 8.8 14.2 Cookstown 3.0 0.0 5.9 11.7 20.1 16.9 19.5 8.3 3.0 Larne 29.1 12.9 12.9 16.1 19.2 6.4 16.0 6.4 29.1 Magherafelt 5.0 4.9 4.8 12.0 7.1 13.9 6.8 6.8 5.0 Moyle 6.2 12.3 12.2 6.1 24.2 6.0 11.9 11.8 6.2 Newtownabbey 11.2 12.5 16.2 9.9 9.9 13.5 19.3 14.4 11.2 Southern LCG 9.3 7.6 10.3 12.8 11.9 8.7 12.5 10.9 11.3 Armagh 9.1 10.8 14.6 17.9 5.3 8.7 8.6 8.5 9.1 Banbridge 4.7 4.6 11.4 6.7 11.0 4.3 6.4 10.5 4.7 Craigavon 9.8 12.2 14.4 13.0 6.9 11.3 11.0 10.8 9.8 Dungannon 4.1 8.2 10.1 9.9 9.6 16.6 10.8 7.1 4.1 Newry and Mourne 7.9 12.3 12.2 10.9 10.7 17.8 14.4 16.2 7.9 South Eastern LCG 8.7 10.8 13.2 17.6 15.0 12.2 12.7 14.7 16.3 Ards 13.5 14.8 21.4 18.6 9.2 15.6 12.9 25.6 13.5 Down 9.3 10.7 12.0 16.3 14.6 10.1 15.8 11.4 9.3 Lisburn 10.1 10.0 19.0 10.8 9.7 13.2 13.9 12.9 10.1 North Down 10.4 18.2 16.7 16.6 16.5 11.4 16.5 16.3 10.4 Western LCG 8.5 14.4 9.8 16.3 8.6 17.1 16.3 11.8 18.1 Derry 16.0 15.0 12.2 12.1 25.0 23.0 16.5 28.3 16.0 Fermanagh 13.8 5.1 15.2 6.7 13.2 8.2 8.1 14.4 13.8 Limavady 9.0 0.0 23.5 11.7 8.7 11.6 8.8 8.8 9.0 Omagh 22.5 12.1 16.0 5.9 7.8 11.6 11.5 9.5 22.5 Strabane 5.2 7.8 23.3 2.6 20.4 20.3 7.6 15.0 5.2 Total 12.2 14.0 12.6 14.9 14.3 14.2 16.1 15.5 15.8 31
Table H: Number and rate of alcohol related deaths 2005-2009 by Local Government District Local Government District Alcohol related deaths 2005-2009 Number of alcohol Crude rate (per 100,000)* Antrim 34 13.0 Ards 63 16.4 Armagh 28 9.7 Ballymena 38 12.3 Ballymoney 24 16.2 Banbridge 18 7.8 Belfast 354 26.4 Carrickfergus 30 15.1 Castlereagh 48 14.6 Coleraine 35 12.3 Cookstown 27 15.3 Craigavon 47 10.6 Derry 114 21.0 Down 47 13.6 Dungannon 29 10.8 Fermanagh 31 10.1 Larne 20 12.8 Limavady 17 9.9 Lisburn 69 12.1 Magherafelt 20 9.3 Moyle 10 12.0 Newry and Mourne 67 14.1 Newtownabbey 55 13.4 North Down 61 15.5 Omagh 24 9.3 Strabane 26 13.2 Northern Ireland 1336 15.2 *Crude rates calculated using mid-year population estimates 32
Table I: Admissions 1 to HSC Hospitals with an 2 Alcohol Related Diagnosis in the primary diagnosis field, from 1999/2000 to 2009/2010, by 5 Year Age Band, using Scottish ICD codes Five year age band 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 Total M F M F M F M F M F M F M F M F M F M F M F M F 0-14 46 45 37 40 32 32 36 38 32 37 35 37 28 31 25 21 24 27 22 36 21 34 338 378 15-19 79 75 77 75 84 63 76 51 51 54 66 64 56 41 67 38 81 45 69 48 63 61 769 615 20-24 68 34 57 33 59 37 39 29 52 30 68 22 84 25 58 17 80 30 77 30 80 27 722 314 25-29 94 18 88 36 99 37 99 22 94 26 117 20 102 23 80 34 136 41 94 28 104 32 1,107 317 30-34 126 29 162 50 211 51 183 53 141 57 149 50 177 39 115 43 162 39 174 34 167 58 1,767 503 35-39 262 61 297 75 330 97 299 74 276 82 291 89 282 104 247 88 296 101 250 98 256 113 3,086 982 40-44 274 60 279 105 323 137 316 141 347 123 437 128 360 128 339 120 369 137 406 146 401 122 3,851 1,347 45-49 225 80 239 85 226 79 269 115 281 109 312 128 352 113 326 131 446 146 475 161 470 154 3,621 1,301 50-54 152 57 208 74 225 76 261 78 227 82 242 91 282 98 248 105 331 83 321 106 345 139 2,842 989 55-59 141 42 131 53 179 61 189 55 175 47 174 69 209 57 194 77 223 75 212 81 240 87 2,067 704 60-64 115 27 120 21 92 25 124 29 132 47 137 68 132 45 160 53 177 57 169 56 204 66 1,562 494 65-69 56 18 89 16 76 24 71 25 73 21 100 31 98 39 80 27 110 33 103 16 100 35 956 285 70-74 36 9 33 8 28 10 32 11 33 20 44 14 41 14 40 16 38 13 38 16 47 12 410 143 75-79 14-17 - 16 7 18 10 15 7 20-21 - 23-19 - 23-18 7 204 54 80-84 - - - - - - - - - - - - 8 6 - - - - - - - - 61 33 85 + - - - - - - - - - - - - - - - - - - - - - - 41 25 Total 1,697 566 1,844 675 1,990 741 2,015 733 1,933 745 2,199 821 2,234 770 2,013 777 2,508 836 2,448 868 2,523 952 23,404 8,484 Source: Hospital Inpatient System 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. 2 ICD-10 codes used to identify alcohol related admissions are available in the appendix P38. Cells containing values less than five have been masked. Where the value in the masked cell would be revealed by providing totals, the next highest value has also been masked. 33
Table J: Admissions 1 to HSC Hospitals with an 2 Alcohol Related Diagnosis in any diagnostic field, from 1999/2000 to 2009/2010, by 5 Year Age Band, using Scottish ICD codes Five year age band 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 Total M F M F M F M F M F M F M F M F M F M F M F M F 0-14 70 58 53 50 44 45 57 53 51 50 55 57-37 43-38 38 41 63 33 56 525 540 15-19 275 173 286 196 293 182 297 197 273 158 314 224 267 157 287 165 325 222 318 210 327 221 3,262 2,105 20-24 352 144 357 167 372 171 355 179 376 174 405 182 389 185 398 161 480 211 465 189 494 176 4,443 1,939 25-29 357 129 423 176 453 155 358 157 398 133 387 143 384 185 382 184 522 174 470 186 448 170 4,582 1,792 30-34 422 177 545 250 645 226 581 216 539 228 537 242 516 235 446 181 498 188 523 173 481 194 5,733 2,310 35-39 694 264 863 296 929 402 886 334 816 340 847 360 736 386 755 316 824 359 771 320 744 349 8,865 3,726 40-44 670 258 829 380 933 448 892 437 1,013 397 1,091 427 983 435 960 398 1,075 491 1,086 455 1,046 432 10,578 4,558 45-49 561 228 675 264 692 334 736 370 814 362 864 390 943 392 1,001 399 1,144 484 1,251 506 1,269 501 9,950 4,230 50-54 491 182 642 226 675 240 733 272 655 292 798 308 831 293 762 328 1,000 306 1,009 384 950 413 8,546 3,244 55-59 446 128 466 160 605 206 613 204 586 171 593 244 635 228 651 230 747 271 750 284 753 293 6,845 2,419 60-64 339 90 396 85 363 93 428 119 504 147 497 180 497 174 575 198 613 173 633 204 670 198 5,515 1,661 65-69 237 67 318 72 307 80 308 88 332 75 380 96 376 109 344 106 433 132 444 135 496 149 3,975 1,109 70-74 136 33 197 46 209 59 199 46 189 65 243 60 237 51 189 70 227 64 258 79 275 75 2,359 648 75-79 99 19 100 28 115 34 114 50 117 39 125 33 138 20 129 23 175 27 146 26 145 40 1,403 339 80-84 37-45 18 35 21 41 19 55 15 47-51 22 59 14 66 19 76 30 73 26 585 217 85 + 12-13 10 19 17 14 8 20 9 24 - - 12 28 11 40 15 29 13 31 15 238 123 Total 5,198 1,969 6,208 2,424 6,689 2,713 6,612 2,749 6,738 2,655 7,207 2,973 7,031 2,921 7,009 2,817 8,207 3,174 8,270 3,257 8,235 3,308 77,404 30,960 Source: Hospital Inpatient System 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. 2 ICD-10 codes used to identify alcohol related admissions are available in the appendix P38. Cells containing values less than five have been masked (-). Where the value in the masked cell would be revealed by providing totals, the next highest value has also been masked. 34
Table K: Admissions 1 to HSC Hospitals with an 2 Alcohol Related Diagnosis in the primary diagnosis field, from 1999/2000 to 2009/2010, by Primary Diagnosis, USING SCOTTISH CODES Primary 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 Diagnosis E512 6 9 6 9 13 10 6 15 14 12 14 F10 1,450 1,591 1,717 1,723 1,613 1,883 1,880 1,786 2,324 2,317 2,512 G312 5 6 12 10 10 15 12 9 12 7 - G621 6 - - - - 5 - - 8-5 G721 - - - - 5 - - - 0 - - I426 7 9 8 12 12 5 13 9 10 18 8 K292 204 179 233 205 204 207 200 138 136 143 134 K70 358 393 417 464 508 551 567 586 593 571 553 K860 90 142 177 155 152 168 185 142 113 136 141 O354-0 0 0-0 0 0 0-0 Q860 0 0 0 0 0-0 - - 0 0 R780 10 15 12 11-5 - - - - - T510 72 87 93 88 64 82 65 39 86 73 65 T511 0 - - - - 5 0 0 0 - - T519 41 57 35 58 74 58 68 45 33 25 29 X45 0-0 0 0 0 0 0 0 0 0 X65 0-0 0 0 0 0 0 0 0 0 Y90 0-0 0 0 0 0 0 0 0 0 Y91 0 - - 0-0 0 0 0-0 Y15 0 0 0 0 0 0 0 0-0 0 Y573 0 0 0 0 0 0 0 0-0 0 Z502 10 16 13 5 11 19-12 10 - - Z714 0 0 0 0 - - 0-0 0 0 Z721 - - 0-0 0 0 - - 0 - Total 2,263 2,519 2,731 2,748 2,678 3,020 3,004 2,790 3,344 3,316 3,475 Source: Hospital Inpatient System 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. 2 ICD-10 codes used to identify alcohol related admissions are available in the appendix P38. Cells containing values less than five have been masked (-). Where the value in the masked cell would be revealed by providing totals, the next highest value has also been masked. 35
Table L: Admissions 1 to HSC Hospitals with an 2 Alcohol Related Diagnosis in the Primary Diagnosis Field, from 1999/2000 to 2009/2010, by Primary Diagnosis and Gender ICD-10 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 M F M F M F M F M F M F M F M F M F M F M F F10 1,090 360 1,153 438 1,264 453 1,249 474 1,174 439 1,403 480 1,415 465 1,327 459 1,779 545 1,741 576 1,864 648 K70 263 95 282 111 285 132 329 135 340 168 344 207 375 192 378 208 406 187 383 188 346 207 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 2 ICD-10 codes used to identify alcohol related admissions are: F10 Mental and behavioural disorders due to use of alcohol K70 Alcoholic liver disease Note: These codes have been searched for in the Primary diagnostic field only. 36
Table M: Admissions 1 to HSC Hospitals with an 2 Alcohol Related Diagnosis in one of the 7 diagnostic fields, tabled by the most dominant Alcohol Related Diagnosis, from 1999/2000 to 2009/2010, by 5 Year Age Band, USING SCOTTISH CODES Main alcohol 1999/2000 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 related diagnosis M F M F M F M F M F M F M F M F M F M F M F E512 5 4 15 5 5 4 11 6 9 10 13 4 10 4 15 11 22 13 18 9 17 3 F10 3,286 999 3,805 1,288 4,072 1,351 3,850 1,280 3,869 1,283 4,175 1,347 4,172 1,347 4,267 1,349 5,244 1,630 5,162 1,651 5,272 1,694 G312 8-7 5 13-13 - 12-17 - 12-15 7 14-5 - 12 - G621 6 - - - - - 6 0 - - 10-8 - 7 6 11 - - - 8 0 G721 - - - - - - - - 6 - - 0-0 5 0 0 - - 0-0 I426 15-32 - 21-27 - 29 0 15 0 28-31 - 33 0 36-23 5 K292 187 34 169 45 204 61 193 62 185 53 193 47 185 40 123 37 119 38 120 39 116 37 K70 417 146 478 174 485 199 527 229 606 277 603 335 676 349 743 359 776 359 802 380 720 415 K860 90 11 164 16 196 23 176 21 170 21 190 21 208 29 165 40 136 35 167 33 185 34 O354 0-0 0 0 0 0 0 0 - - 0 0 0 0 0 0 0 0-0 0 Q860-0 - - - - - - 6 0 6 0 0 0 - - 6-7 0 - - R780 23 11 24 14 26 16 18 7 8-7 8 5 - - - 5 - - 8 0 5 T510 382 431 483 461 487 564 510 594 534 511 527 510 416 458 521 521 481 463 546 495 514 497 T511 0 0 - - 6-0 - - 0 - - - 0 - - 0 0-0 0 - T519 75 86 103 96 108 92 148 136 157 129 205 202 269 229 188 147 155 140 152 102 87 56 X45 - - - - - - 0 0-0 0-0 - - 0 - - - 0 0 - X65 8 10 9 6 10 10 5 7 8 6 8 8 7 9 16 16 6 11 6 6 7 7 Y15-0 0 0-0 - 0 0 0-0 0 0 0 0 0 - - - 0 - Y573 0-0 - 0 0 0 0 0 0 0 0 0 0 0 0-0 0 - - 0 Y90 134 47 163 87 185 96 161 84 140 68 166 70 111 49 136 64 160 99 167 85 174 98 Y91 480 160 512 137 590 177 666 216 705 200 706 200 573 167 515 170 683 215 695 248 723 265 Z502 8 5 10 7 13-6 - 15-21 - - - 15-11 5 6-8 7 Z714 6 - - - 7-17 0 13-5 - - - - - 10-8 - 5 - Z721 62 14 217 70 253 98 271 95 259 84 331 206 343 225 236 79 332 146 361 185 358 172 Total 5,198 1,969 6,208 2,424 6,689 2,713 6,612 2,749 6,738 2,655 7,207 2,973 7,031 2,921 7,009 2,817 8,207 3,174 8,270 3,257 8,235 3,308 Source: Hospital Inpatient System: 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.2 ICD-10 codes used to identify alcohol related admissions are available in the appendix P38. Note: Each hospital admission has only been counted once, and the admissions have been tabled only by the ICD-10 code which appeared in the most dominant diagnostic position. i.e. If the codes 'F10' appeared in the primary diagnosis field, and there was a subsequent diagnosis of 'K70' in the same admission, the admission would be recorded in the 'F10' group only. Cells containing values less than five have been masked (-). 37
Alcohol related death UK definition 1. In Northern Ireland, all deaths are coded according to the International Classification of Diseases Ninth Revision (ICD-09) for 1999 to 2000 and Tenth Revision (ICD-10) for 2001 onwards. This is in line with the rest of the United Kingdom. 2. Deaths are identified as being alcohol related deaths using the underlying cause of death according to the current National Statistics definition: International Classification of Diseases, Ninth Revision (ICD-9) 291 Alcoholic psychoses 303 Alcohol dependence syndrome 305.0 Non-dependent abuse of alcohol 425.5 Alcoholic cardiomyopathy 571 Chronic liver disease and cirrhosis (Excluding 571.6 - Biliary cirrhosis) E860 Accidental poisoning by alcohol International Classification of Diseases, Tenth Revision (ICD-9) F10 Mental and behavioural disorders due to use of alcohol G31.2 Degeneration of nervous system due to alcohol G62.1 Alcoholic polyneuropathy I42.6 Alcoholic cardiomyopathy K29.2 Alcoholic gastritis K70 Alcoholic liver disease K73 Chronic hepatitis, not elsewhere classified K74 Fibrosis and cirrhosis of liver (Excluding K74.3-K74.5 - Biliary cirrhosis) K86.0 Alcohol induced chronic pancreatitis X45 Accidental poisoning by and exposure to alcohol X65 Intentional self-poisoning by and exposure to alcohol Y15 Poisoning by and exposure to alcohol, undetermined intent Alcohol related hospital admissions ICD 10 codes The following ICD-10 codes (as used by Scotland) have been used to identify alcohol related admissions: E244 E512 F10 G312 G621 G721 I426 K292 K70 K860 O354 P043 Q860 R780 T510 T511 T519 X45 X65 Y15 Y573 Y90 Y91 Z502 Z714 Z721 Alcohol-induced pseudo-cushing's syndrome Wernicke's encephalopathy Mental and behavioural disorders due to use of alcohol Degeneration of nervous system due to alcohol Alcoholic polyneuropathy Alcoholic myopathy Alcoholic cardiomyopathy Alcoholic gastritis Alcoholic liver disease Alcohol-induced chronic pancreatitis Maternal care for (suspected) damage to fetus from alcohol Fetus and newborn affected by maternal use of alcohol Fetal alcohol syndrome (dysmorphic) Finding of alcohol in blood Ethanol Methanol Alcohol, unspecified Accidental poisoning by and exposure to alcohol Intentional self-poisoning by and exposure to alcohol Poisoning by and exposure to alcohol, undetermined intent Alcohol deterrents Evidence of alcohol involvement determined by blood alcohol level Evidence of alcohol involvement determined by level of intoxication Alcohol rehabilitation Alcohol abuse counselling and surveillance Alcohol use 38
References 1. World Health Organisation. Global status report on alcohol and health 2011. Geneva: WHO, 2011. www.who.int/substance_abuse/publications/global_alcohol_report/en/ 2. Eurobarometer. Attitudes toward s Alcohol. 2007 http://ec.europa.eu/public_opinion/archives/ebs/ebs_272b_en.pdf 3. Smith L and Foxcroft D. Drinking patterns in the UK. An exploration of trends. York: Joseph Rowntree Foundation, 2009. www.jrf.org.uk/sites/files/jrf/uk-alcohol-trends-full.pdf 4. Department of Health, Social Services and Public Safety. The Social costs of alcohol misuse in Northern Ireland for 2008/09. Belfast: DHSSPS, 2010. www.dhsspsni.gov.uk/social_costs_of_alcohol_misuse_200809.pdf 5. Institute of Alcohol Studies. Alcohol and health. Cambridge: IAS, 2010. 6. Scottish Government, The Societal Cost of Alcohol Misuse in Scotland for 2007, 2010. www.scotland.gov.uk/resource/doc/297819/0092744.pdf 7. Department of Health, The Cost of Alcohol Harm to the NHS in England, 2008. www.dh.gov.uk/en/ Consultations/Liveconsultations/DH_086412?IdcService=GET_FILE&dID=169373&Rendition=Web 8. Department of Health, Social Services and Public Safety. Adult drinking patterns in Northern Ireland 2008. Belfast, DHSSPS, 2008. www.dhsspsni.gov.uk/adult_drinking_patterns_report_2008.pdf 9. Secondary Analysis of the 2003 Young Persons Behaviour and Attitudes Survey (Drugs, Solvents, Alcohol and Smoking) www.dhsspsni.gov.uk/ypbas-2003.pdf 10. Secondary Analysis of the 2007 Young Persons Behaviour and Attitudes Survey (Drugs, Solvents, Alcohol and Smoking) www.dhsspsni.gov.uk/secondary_analysis_of_2007_ypbas.pdf 11. Drinking behaviour among young people in Northern Ireland: secondary analysis of alcohol data from 1997 to 2003. www.healthpromotionagency.org.uk/resources/alcohol/temperancereport.htm 12. Rabinovich L, Brutscher P, de Vries H, Tiessen J, Clift J and Reding A. The affordability of alcoholic beverages in the European Union Understanding the link between alcohol affordability, consumption and harms. Cambridge: RAND, 2009. http://ec.europa.eu/health/archive/ph_determinants/life_style/alcohol/documents/alcohol_rand_en.pd f 13. Alcohol statistics Scotland. Edinburgh: National Services Scotland, 2010. www.alcoholinformation.isdscotland.org/alcohol_misuse/files/alcohol_stats_bulletin_2011.pdf 14. Department for Environment, Food and Rural Affairs Family food. A report on the 2009 Family food module of the Living Costs and Food Survey. London: DEFRA, 2010. www.defra.gov.uk/corporate/evidence/statistics/foodfarm/food/familyfood/documents/familyfood- 2009.pdf 15. Office for National Statistics. Alcohol-related deaths in the United Kingdom, 2000 2009. Newport: ONS, 2011. www.statistics.gov.uk/pdfdir/alc0111.pdf 16. Durkin A, Connolly S and O Reilly D. Quantifying Alcohol-Related Mortality: Should Alcohol-Related Contributory Causes of Death be Included? Alcohol and Alcoholism 2010; 45(4): 374-378. 17. Northern Ireland Statistics and Research Agency. Alcohol related deaths registered in Northern Ireland (1999-2009). Belfast: NISRA, 2010. www.nisra.gov.uk/archive/demography/publications/alcohol_deaths/alcoholdeaths09.pdf 18. Department of Health, Social Services and Public Safety. Northern Ireland Health and Social Care Inequalities Monitoring System Third Update Bulletin 2009. Belfast: DHSSPS, 2009. www.dhsspsni.gov.uk/inequalities_monitoring_update3.pdf 19. Department of Health, Social Services and Public Safety. Northern Ireland Health and Social Care Inequalities Monitoring System Sub-regional Inequalities HSC Trusts 2010. Belfast: DHSSPS, 2010. www.dhsspsni.gov.uk/subreg_inequalities_monitoring_1.pdf 20. Connolly S, O Reilly D, Rosato M and Cardwell C. Area of residence and alcohol-related mortality risk: a five-year follow-up study. Addiction 2011; 106 (1): 84-92. 21. NI Health & Social Care Inequalities Monitoring System Life Expectancy Decomposition. An overview of changes in Northern Ireland life expectancy 2001-03 to 2006-08. www.dhsspsni.gov.uk/hscims_life_expectancy_decomposition_2011.pdf 22. Northern Ireland Statistics and Research Agency. Census of Drug and Alcohol Treatment Services in Northern Ireland: 1 st March 2010. Belfast: NISRA, 2010. www.dhsspsni.gov.uk/census_bulletin_- _1_march_2010.pdf 23. Northern Ireland Statistics and Research Agency. Statistics from the Northern Ireland Drug Misuse Database: 1 April 2009-31March 2010. Belfast, NISRA, 2010. www.dhsspsni.gov.uk/dmd_bulletin_2009_10.pdf 39
Further sources of information Scotland www.scotpho.org.uk/home/behaviour/alcohol/alcohol_keydatasources.asp General Register Office for Scotland www.gro-scotland.gov.uk/statistics/theme/vital-events/deaths/alcohol-related/index.html www.gro-scotland.gov.uk/files2/stats/annual-review-09/rgar2009.pdf England Office for National Statistics www.statistics.gov.uk/cci/searchres2.asp?ips=5&ct=3&term=alcohol www.statistics.gov.uk/cci/searchres.asp?term=alcohol&x=33&y=3 The Information Centre for Health and Social Care www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/alcohol Statistics on alcohol: England 2010 www.ic.nhs.uk/webfiles/publications/alcohol10/statistics_on_alcohol_england_2010.pdf Wales www.wales.nhs.uk/healthtopics/lifestyles/alcohol A profile of alcohol and health in Wales www.wales.nhs.uk/sites3/documents/568/alcohol%20and%20health%20in%20wales_we bfinal_e.pdf Future proof: Can we afford the cost of drinking too much? mortality morbidity and drinkdriving in the UK www.alcoholconcern.org.uk/assets/files/publications/future%20proof.pdf Ireland Alcohol Related Harm in Ireland. www.hse.ie/eng/services/publications/services/hospitals/alcohol_related_harm_in_irelan d.pdf Alcohol Related Harm in Ireland. http://alcoholireland.ie/wp-content/uploads/2011/02/health-related-consequences-ofproblem-alcohol-use-hrb-2009.pdf Overview. Health-related consequences of problem alcohol use. http://alcoholireland.ie/wp-content/uploads/2011/02/health-related-consequences-ofproblem-alcohol-use-hrb-2009.pdf This briefing has been produced by Health Intelligence in the Public Health Agency Northern Ireland. If you would like further information please contact: healthintelligence@hscni.net or Julie.Neill@hscni.net or phone 028 90311611 40