Alcohol-attributable Hospital Research Articles

Associations between alcohol intake and hospital contacts due to alcohol and unintentional injuries in 71,025 Danish adolescents – a prospective cohort study

Alcohol is a leading risk factor to adolescent health. However, it is unclear how associations between alcohol intake and injuries are shaped. We investigated the dose-response relationship between alcohol intake and risk of hospital contacts due to alcohol and unintentional injuries in adolescents. We conducted a prospective cohort study including 71,025 Danish students aged 15-24 years, followed up for five years from 2014 to 2019. The main outcome measures were hospital contacts due to alcohol and unintentional injuries (all injuries and head injuries), obtained from hospital registers. Approximately 90% of males and females reported drinking alcohol, and the median intake among those was 11 drinks/week in males and 8 drinks/week in females. During five years of follow-up, 1.3% had an alcohol-attributable hospital contact, the majority of which were due to acute intoxication (70%). Alcohol-attributable hospital contacts were equally frequent in males and females and between age groups (15-17-year-olds vs 18-24-year-olds). Compared with never drinking, the adjusted incidence rate ratios for weekly intake of <7, 7-13, 14-20, 21-27, and >27 drinks/week were 1.70 (95% confidence interval 1.23-2.34), 1.77 (1.27-2.46), 1.91 (1.35-2.70), 2.34 (1.59-3.46), and 3.25 (2.27-4.64) for having an alcohol-attributable hospital contact within five years of follow-up. Restricting follow-up to one year more than doubled risk estimates. During the five years of follow-up, 27% incurred an unintentional injury. The most frequent types of injury were to the wrist or hand (27.6%), ankle or foot (25.2%), or head (12.4%). Injuries were more frequent among males (first-time incidence rate 110 per 1000 person-years) compared to females (82 per 1000 person-years), with no differences between age groups. Compared with never drinking, the adjusted incidence rate ratios for weekly intake of <7, 7-13, 14-20, 21-27, and >27 drinks were 1.09 (1.03-1.15), 1.14 (1.07-1.20), 1.25 (1.17-1.33), 1.38 (1.28-1.49), and 1.58 (1.47-1.69) for having a hospital contact for any type of unintentional injury within five years of follow-up. Results for the one-year follow-up period were comparable. Separate analysis for head injuries showed similar results as the analysis on all injuries. Results were generally similar in males and females. Adolescents' drinking is associated with a higher risk of acute harm in terms of hospital contacts due to alcohol and unintentional injuries in a dose-response relationship. Thus, increased risk was apparent in those with low alcohol intake, suggesting a need for awareness of and initiatives to prevent youth drinking. Furthermore, initiatives should include a strengthened focus on people younger than 18 years. This study was funded by the Tryg Foundation (ID: 153539) and The Helse Foundation (21-B-0359).

Socioeconomic inequalities in alcohol-related harm in adolescents: a prospective cohort study of 68,299 Danish 15–19-year-olds

Evidence shows that similar levels of alcohol consumption lead to greater harm in adults with low socioeconomic position (SEP) compared to high SEP. We investigated if SEP is associated with alcohol-related hospital contacts in adolescents, and whether differences in risk can be explained by differences in levels of alcohol consumption, drinking pattern, and substance use. This is a prospective cohort study of 68,299 participants aged 15-19 years old from the Danish National Youth Cohort 2014. SEP was operationalised as parent educational level, family income and perceived financial strain in the family. Data were linked to national registers and participants were followed up for five years from 2014 to 2019. Outcomes were hospital contacts due to alcohol. Multilevel Poisson regression was used to estimate incidence rates (IR) and incidence rate ratios (IRR). During 280,010 person years of follow-up, 872 participants had an alcohol-attributable hospital contact; intoxications (n=778, 89%) were the most common diagnosis. Low as compared to high SEP was associated with higher IRR of alcohol-attributable hospital contacts for all three SEP measures. The adjusted IRR of harm was 1.73 (95% CI: 1.29-2.33) for elementary school as the highest parent education compared to longer parent education and 1.57 (95% CI: 1.30-1.89) for family financial strain compared to those without financial strain. Adjustment for weekly alcohol intake, drinking pattern and substance use did not substantially change results. Cubic spline analysis of the association between family income and alcohol-attributable hospital contacts revealed a dose-response relationship with decreasing risk of alcohol-related harm with higher income. Our findings suggested that alcohol-related harm is more common in socioeconomically disadvantaged adolescents despite similar levels of alcohol consumption, regardless of differences in drinking pattern or substance use. Future preventive strategies should prioritise young adolescents, including those who are most disadvantaged. Tryg Foundation (ID: 153539).

Trends in alcohol-attributable hospitalisations and emergency department visits by age, sex, drinking group and health condition in Ontario, Canada.

Alcohol-attributable harms are increasing in Canada. We described trends in alcohol-attributable hospitalisations and emergency department (ED) visits by age, sex, drinking group, attribution and health condition. Hospitalisation and ED visits for partially or wholly alcohol-attributable health conditions by age and sex were obtained from population-based health administrative data for individuals aged 15+ in Ontario, Canada. Population-level alcohol exposure was estimated using per capita alcohol sales and alcohol use data. We estimated the number and rate of alcohol-attributable hospitalisations (2008-2018) and ED visits (2008-2019) using the International Model of Alcohol Harms and Policies(InterMAHP). Over the study period, the modelled rates of alcohol-attributable health-care encounters were higher in males, but increased faster in females. Specifically, rates of alcohol-attributable hospitalisations and ED visits increased by 300% (19-76 per 100,000) and 37% (774-1,064 per 100,000) in females, compared to 20% (322-386 per 100,000) and 2% (2563-2626 per 100,000) in males, respectively. Alcohol-attributable ED visit rates were highest among individuals aged 15-34, however, increased faster among individuals aged 65+ (females: 266%; males: 44%) than 15-34 years (females:+17%; males: -16%). High-volume drinkers had the highest rates of alcohol-attributable health-care encounters; yet, low-/medium-volume drinkers contributed substantial hospitalisations (11%) and ED visits (36%), with increasing rates of ED visits in females drinking low/medium volumes. Alcohol-attributable health-care encounters increased overall, and faster among females, adults aged 65+ and low-/medium-volume drinkers. Monitoring trends across subpopulations is imperative to inform equitable interventions to mitigate alcohol-attributable harms.

Classifying alcohol control policies enacted between 2000 and 2020 in Poland and the Baltic countries to model potential impact.

The study's aim is to identify and classify the most important alcohol control policies in the Baltic countries (Estonia, Latvia and Lithuania) and Poland between 2000 and 2020. Policy analysis of Baltic countries and Poland, predicting potential policy impact on alcohol consumption, all-cause mortality and alcohol-attributable hospitalizations was discussed. All Baltic countries implemented stringent availability restrictions on off-premises trading hours and different degrees of taxation increases to reduce the affordability of alcoholic beverages, as well as various degrees of bans on alcohol marketing. In contrast, Poland implemented few excise taxation increases or availability restrictions and, in fact, reduced stipulations on prior marketing bans. This classification of alcohol control policies in the Baltic countries and Poland provides a basis for future modeling of the impact of implementing effective alcohol control policies (Baltic countries), as well as the effects of loosening such policies (Poland).

Heavy metal toxicity and mortality—association between density of heavy metal bands and cause specific hospital admissions and mortality: population based cohort study

ObjectiveTo assess the association between area level density of heavy metal bands and cause specific hospital admissions and mortality.DesignLongitudinal register based cohort study.Setting311 municipalities in Finland.Participants3 644 944 people aged...

Demographics and clinical characteristics of alcohol-related admissions in a tertiary care hospital in Qatar: Does age matter?

Background: Alcohol consumption is a major cause of acute and chronic health conditions associated with comorbidities and traumatic injuries, despite its partial prohibition in some countries. Moreover, alcohol-related hospital admissions increase the burden on the healthcare system. More than 80% of the population in Qatar comprises expatriates. This study aimed to analyze the demographics and clinical characteristics of subjects with alcohol-related emergency department (ED) visits/hospitalization with respect to different age groups in a single tertiary hospital in Qatar.Methods: It is a retrospective observational study of adult patients who visited the ED at Hamad General Hospital between January 2013 and March 2015 and were screened positive for alcohol use. Collected data included sociodemographic characteristics, blood alcohol concentration (BAC), pattern of admission, previous medical history, laboratory investigations, treatment, hospital course, and mortality. Data were compared with respect to the distribution of age groups such as < 25, 25–34, 35–44, 45–54, and >55 years.Results: In total, 1506 consecutively admitted patients screened positive for alcohol use were included in the study; the majority of them were males (95.6%), non-Qatari nationals (71.1%), and aged 35–44 years (30.9%). The age groups 35–44 years and 45–54 years showed the highest median BAC ([0.24 interquartile range (IQR: 0.14–0.33)] and [0.24 (IQR: 0.13–0.33)], respectively) as compared to the other age groups (P = 0.001). The pattern of hospital admission, sociodemographic status, presence of comorbidities, laboratory investigations, and mortality showed specific age-related distribution. Particularly, young adults were more likely to have a previous ED visit due to trauma, whereas older patients’ previous hospital admissions were mostly related to various underlying comorbidities.Conclusion: This study highlighted the patterns of age and clinico-epidemiological status of patients with alcohol-attributable hospital admissions. Our study showed that alcohol consumption was higher among the working-age group. Further studies are needed to investigate changes in the alcohol consumption patterns that may help plan for allocation of health resources and prevention of alcohol-related problems.

Alcohol policy and gender: a modelling study estimating gender-specific effects of alcohol pricing policies.

To describe gender differences in alcohol consumption, purchasing preferences and alcohol-attributable harm. To model the effects of alcohol pricing policies on male and female consumption and hospitalizations. Epidemiological simulation using the Sheffield Alcohol Policy Model version 4. Adults aged 18+years, England. Three alcohol pricing policies: 10% duty increase and minimum unit prices (MUP) of £0.50 and £0.70 per UK unit. Gender-specific baseline and key outcomes data: annual beverage-specific units of alcohol consumed and beverage-specific alcohol expenditure (household surveys). Alcohol-attributable hospital admissions (administrative data). Key model parameters: literature-based own- and cross-price elasticities for 10 beverage-by-location categories (e.g. off-trade beer). Sensitivity analysis with new gender-specific elasticities. Literature-based risk functions linking consumption and harm, gender-disaggregated where evidence was available. Population subgroups: 120 subgroups defined by gender (primary focus), age, deprivation quintile and baseline weekly consumption. Women consumed 59.7% of their alcohol as off-trade wine while men consumed 49.7% as beer. Women drinkers consumed fewer units annually than men (494 versus 895) and a smaller proportion of women were high-risk drinkers (4.8 versus 7.2%). Moderate drinking women had lower hospital admission rates than men (44 versus 547 per 100 000), but rates were similar for high-risk drinking women and men (14 294 versus 13 167 per 100 000). All three policies led to larger estimated reductions in consumption and admission rates among men than women. For example, a £0.50 MUP led to a 5.3% reduction in consumption and a 4.1% reduction in admissions for men but a 0.7% reduction in consumption and a 1.6% reduction in hospitalizations for women. Alcohol consumption, purchasing preferences and harm show strong gender patterns among adult drinkers in England. Alcohol pricing policies are estimated to be more effective at reducing consumption and harm for men than women.

Potential effects of minimum unit pricing at local authority level on alcohol-attributed harms in North West and North East England: a modelling study

Background In 2018, Scotland implemented a 50p-per-unit minimum unit price for alcohol. Previous modelling estimated the impact of minimum unit pricing for England, Scotland, Wales and Northern Ireland. Decision-makers want to know the potential effects of minimum unit pricing for local authorities in England; the premise of this study is that estimated effects of minimum unit pricing would vary by locality. Objective The objective was to estimate the potential effects on mortality, hospitalisations and crime of the implementation of minimum unit pricing for alcohol at local authority level in England. Design This was an evidence synthesis, and used computer modelling using the Sheffield Alcohol Policy Model (local authority version 4.0). This study gathered evidence on local consumption of alcohol from the Health Survey for England, and gathered data on local prices paid from the Living Costs and Food Survey and from market research companies’ actual sales data. These data were linked with local harms in terms of both alcohol-attributable mortality (from the Office for National Statistics) and alcohol-attributable hospitalisations (from Hospital Episode Statistics) for 45 conditions defined by the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. These data were examined for eight age–sex groups split by five Index of Multiple Deprivation quintiles. Alcohol-attributable crime data (Office for National Statistics police-recorded crimes and uplifts for unrecorded offences) were also analysed. Setting This study was set in 23 upper-tier local authorities in North West England, 12 upper-tier local authorities in the North East region and nine government office regions, and a national summary was conducted. Participants The participants were the population of England aged ≥ 18 years. Intervention The intervention was setting a local minimum unit price. The base case is 50p per unit of alcohol. Sensitivity analyses were undertaken using minimum unit prices of 30p, 40p, 60p and 70p per unit of alcohol. Main outcome measures The main outcome measures were changes in alcohol-attributable deaths, hospitalisations and crime. Savings in NHS costs, changes in alcohol purchasing and consumption, changes in revenue to off-trade and on-trade retailers and changes in the slope index of inequality between most and least deprived areas were also examined. Results The modelling has proved feasible at the upper-tier local authority level. The resulting estimates suggest that minimum unit pricing for alcohol at local authority level could be effective in reducing alcohol-attributable deaths, hospitalisations, NHS costs and crime. A 50p minimum unit price for alcohol at local authority level is estimated to reduce annual alcohol-related deaths in the North West region by 205, hospitalisations by 5956 (–5.5%) and crimes by 8528 (–2.5%). These estimated reductions are mostly due to the 5% of people drinking at high-risk levels (e.g. men drinking &gt; 25 pints of beer or five bottles of wine per week, women drinking &gt; 17 pints of beer or 3.5 bottles of wine per week, and who spend around £2500 per year currently on alcohol). Model estimates of impact are bigger in the North West and North East regions than nationally because, currently, more cheap alcohol is consumed in these regions and because there are more alcohol-related deaths and hospitalisations in these areas. A 30p minimum unit price has estimated effects that are ≈ 90% lower than those of a 50p minimum unit price, and a 40p minimum unit price has estimated effects that are ≈ 50% lower. Health inequalities are estimated to reduce with greater health gains in the deprived areas, where more cheap alcohol is purchased and where there are higher baseline harms. Limitations The approach requires synthesis of evidence from multiple sources on alcohol consumption; prices paid; and incidence of diseases, mortality and crime. Price elasticities used are from previous UK analysis of price responsiveness rather than specific to local areas. The study has not estimated ‘cross-border effects’, namely travelling to shops outside the region. Conclusions The modelling estimates suggest that minimum unit pricing for alcohol at local authority level would be an effective and well-targeted policy, reducing inequalities. Future work The Sheffield Alcohol Policy Model for Local Authorities framework could be further utilised to examine the local impact of national policies (e.g. tax changes) or local policies (e.g. licensing or identification and brief advice). As evidence emerges from the Scottish minimum unit price implementation, this will further inform estimates of impact in English localities. The methods used to estimate drinking and purchasing patterns in each local authority could also be used for other topics involving unhealthy products affecting public health, for example to estimate local smoking or high-fat, high-salt food consumption patterns. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 4. See the NIHR Journals Library website for further project information.

The Potential Health Impact of an Alcohol Minimum Unit Price in Québec: An Application of the International Model of Alcohol Harms and Policies

Alcohol minimum unit pricing is a strategy capable of reducing alcohol-related harm from cheap alcoholic beverages. We used the International Model of Alcohol Harms and Policies (InterMAHP), an open-access alcohol harms estimator and policy scenario modeler, to estimate the potential health benefits of introducing minimum unit pricing in Québec, Canada. Aggregated mortality and hospitalization data were obtained from official administrative sources. Alcohol sales and pricing data were obtained from the partial government retail monopoly and Nielsen. Exposure data were from the Canadian Substance Use Exposure Database. Average price changes under two minimum-unit-pricing scenarios were estimated by applying a product-level pricing analysis. The online InterMAHP tool was used to automate the estimation of observed alcohol-attributable harm and what was projected in each policy scenario. Alcohol was estimated to cause 2,850 deaths and 24,694 hospitalizations in Québec in 2014. Introducing minimum unit pricing of CAD$1.50 was estimated to reduce consumption by 4.4%, alcohol-attributable deaths by 5.9% (95% CI [0.2%, 11.7%]), and alcohol-attributable hospital stays by 8.4% (95% CI [3.2%, 13.7%]). Higher minimum unit pricing of CAD$1.75 was estimated to reduce alcohol-attributable deaths by 11.5% (95% CI [5.9%, 17.2%]) and alcohol-attributable hospital stays by 16.3% (95% CI [11.2%, 21.4%]). The results of this policy modeling study suggest that the introduction of minimum unit pricing between CAD$1.50 and $1.75 would substantially reduce the alcohol-caused burden of disease in Québec. The quantification of alcohol-caused death and disability, and the changes in these measures under two scenarios, was significantly automated by the open-access resource, InterMAHP.

Alcohol use and alcohol-related harm in rural and remote communities: protocol for a scoping review.

IntroductionAlcohol-related harm is a major public health concern and appears to be particularly problematic in rural and remote communities. Evidence from several countries has shown that the prevalence of harmful alcohol use and alcohol-attributable hospitalisations and emergency department visits are higher in rural and remote communities than in urban centres. The extents of this rural–urban disparity in alcohol-related harm as well as the factors that mediate it are poorly understood. The objective of this scoping review is to synthesise the international research on the factors that influence the prevalence or risk of alcohol-related harm in rural and remote communities. This will help to clarify the conceptual landscape of rural and remote alcohol research and identify the gaps in knowledge that need to be addressed.Methods and analysisThis scoping review will access published literature through search strategies developed for Medline, PsycINFO, Embase, CINAHL and Sociological s. There will be no date, country or language restrictions placed on the search. Title and abstract, followed by full-text screening, will be conducted by two independent reviewers to evaluate all identified articles against a set of prespecified inclusion and exclusion criteria. Data from selected articles will be extracted and compiled into a final manuscript that adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist guidelines.Ethics and disseminationThe results of this review will be helpful in guiding future research on rural and remote alcohol use and alcohol-related harm, which will inform more effective, evidence-based public health strategies to reduce alcohol-related harm in rural and remote communities. The results will be disseminated via field-specific conference presentations and peer-reviewed publication.

The impacts of minimum alcohol pricing on alcohol attributable morbidity in regions of British Colombia, Canada with low, medium and high mean family income.

Previous research indicates that minimum alcohol pricing (MAP) is associated negatively with alcohol-attributable (AA) hospitalizations. Modeling studies predict that this association will be stronger for people on lower incomes. The objective of this study was to test whether the association between MAP and AA hospitalizations is greater in low-income regions. Cross-sectional versus time-series analysis using multivariate multi-level effect models. All 89 Local Health Areas in British Columbia (BC), Canada, 2002-13 (48 quarters). BC population. Quarterly rates of AA hospital admissions, mean consumer price index-adjusted minimum dollars per standard alcoholic drink and socio-demographic covariates. Family income was related inversely to the effect of minimum prices on rates of some types of AA morbidity. A 1% price increase was associated with reductions of 3.547% [95% confidence interval (CI)=-5.719, -1.377; P<0.01] in low family-income regions and 1.64% (95% CI=-2.765, -0.519; P<0.01) across all income regions for 100% acute AA hospital admissions. Delayed (lagged) effects on chronic AA morbidity were found 2-3years after minimum price increases for low income regions and all regions combined; a 1% increase in minimum price was associated with reductions of 2.242% (95% CI=-4.097, -0.388; P<0.05) for 100% chronic AA and 2.474% (95% CI=-3.937, -1.011; P<0.01) for partially chronic AA admissions for low-income regions. In Canada, minimum price increases for alcohol are associated with reductions in alcohol attributable hospitalizations, especially for populations with lower income, both for immediate effects on acute hospitalizations and delayed effects on chronic hospitalizations.

Alcohol attributable hospitalizations in resident population of Friuli Venezia Giulia Region, Italy

Alcohol attributable hospitalizations in resident population of Friuli Venezia Giulia Region, Italy

Educational inequalities in hospitalization attributable to alcohol: a population-based longitudinal study of changes during the period 2000-07.

To estimate the relative risk of hospitalization from alcohol-related causes among men and women in Finland across different educational categories, and to determine whether these differentials changed following a large reduction in alcohol prices in 2004. A register-based longitudinal study of hospitalizations. We used repeated-measures analysis to estimate alcohol-attributable hospitalization rates and assessed effects of the reduction in alcohol prices by comparing two 4-year periods (2000-03 and 2004-07). Finland. A representative sample of the residents of Finland aged 30-79 years in the period 2000-07 (n = 470,627). There was a clear gradient across educational levels in alcohol-attributable hospitalizations: the incidence rate ratios among men and women with basic education were 1.70 [95% confidence interval (CI) = 1.32, 2.20] and 1.96 (95% CI = 1.36, 2.84), respectively, compared with those with upper-tertiary education. After allowing for the long-term trend, there were no significant changes between the two follow-up periods either among men with an upper tertiary education or among women in any educational level, whereas the rate increased by 21% (95% CI = 5, 41), 16% (95% CI = 6, 27) and 10% (95% CI = 2, 18), respectively, among men with a lower tertiary, secondary and basic education. However, these differences in changes were not statistically significant. Lower-level education is associated with a substantially increased risk of alcohol-related hospitalization among men and women in Finland, even when adjusted for age, economic activity and income. The results do not provide strong evidence that the 2004 price reduction had differential effects by education.

Temporal Changes in Alcohol-Related Morbidity and Mortality in Germany

Aims: Trends in morbidity and mortality, fully or partially attributable to alcohol, for adults aged 18-64 were assessed for Germany. Methods: The underestimation of population exposure was corrected by triangulating survey data with per capita consumption. Alcohol-attributable fractions by sex and two age groups were estimated for major disease categories causally linked to alcohol. Absolute numbers, population rates and proportions relative to all hospitalizations and deaths were calculated. Results: Trends of 100% alcohol-attributable morbidity and mortality over thirteen and eighteen years, respectively, show an increase in rates of hospitalizations and a decrease in mortality rates. Comparisons of alcohol-attributable morbidity including diseases partially caused by alcohol revealed an increase in hospitalization rates between 2006 and 2012. The proportion of alcohol-attributable hospitalizations remained constant. Rates of alcohol-attributable mortality and the proportion among all deaths decreased. Conclusions: The increasing trend in mortality due to alcohol until the mid-1990s has reversed. The constant proportion of all hospitalizations that were attributable to alcohol indicates that factors such as improved treatment and easier health care access may have influenced the general increase in all-cause morbidity. To further reduce alcohol-related mortality, efforts in reducing consumption and increasing treatment utilization are needed.

Minimum Alcohol Prices and Outlet Densities in British Columbia, Canada: Estimated Impacts on Alcohol-Attributable Hospital Admissions

We investigated whether periodic increases in minimum alcohol prices were associated with reduced alcohol-attributable hospital admissions in British Columbia. The longitudinal panel study (2002-2009) incorporated minimum alcohol prices, density of alcohol outlets, and age- and gender-standardized rates of acute, chronic, and 100% alcohol-attributable admissions. We applied mixed-method regression models to data from 89 geographic areas of British Columbia across 32 time periods, adjusting for spatial and temporal autocorrelation, moving average effects, season, and a range of economic and social variables. A 10% increase in the average minimum price of all alcoholic beverages was associated with an 8.95% decrease in acute alcohol-attributable admissions and a 9.22% reduction in chronic alcohol-attributable admissions 2 years later. A Can$ 0.10 increase in average minimum price would prevent 166 acute admissions in the 1st year and 275 chronic admissions 2 years later. We also estimated significant, though smaller, adverse impacts of increased private liquor store density on hospital admission rates for all types of alcohol-attributable admissions. Significant health benefits were observed when minimum alcohol prices in British Columbia were increased. By contrast, adverse health outcomes were associated with an expansion of private liquor stores.

Risks of alcohol-attributable hospitalisation and death in Australia over time: Evidence of divergence by region, age and sex.

Past reports on trends of alcohol consumption and related harm have generally been descriptive in nature and have not provided evidence of whether changes over time are significant. We investigated whether: (i) the risk of alcohol-attributable hospitalisation and death between 1994 and 2005 for three different age groups changed significantly across all Australian jurisdictions; and (ii) the relative rates of hospitalisation for males and females changed over time. Estimates of alcohol-attributable hospitalisations and deaths were calculated using the aetiologic fraction method. Hospitalisations and deaths were grouped by age: 15-29 years, 30-44 years and 45+ years. Risk estimates and risk differences were analysed using Poisson regression. Risk of alcohol-attributable hospital separations increased nationally and across most jurisdictions throughout the study period. Male and female rates converged over time. Alcohol-attributable deaths decreased nationally across the three age groups and across several jurisdictions beginning in the mid-1990s. Nationally, alcohol-attributable deaths declined while hospitalisations rose. However, states with higher population density tended to drive national rates, with considerable variation by jurisdiction. The conditions which dominated hospitalisations (e.g. alcohol dependence, falls) differed substantially from those underlying alcoholattributable deaths (e.g. alcoholic liver cirrhosis, road crashes). Jurisdictional variation in death and hospitalisations rates as well as changes over time may be partly due to differences in: regulation of alcohol supply; patterns and levels of alcohol consumption; the nature and effectiveness of law enforcement; demographic characteristics of general and sub-populations; and medical health services and screening for chronic conditions.

How much is too much? Alcohol consumption and related harm in the Northern Territory

To present recent estimates of alcohol consumption and its impact on the health of people in the Northern Territory, and to draw comparisons with Australia as a whole. Descriptive study of alcohol consumption in the NT population, based on sales data and self-report surveys, and alcohol-attributable deaths and hospitalisations among people in the NT in the 2004-05 and 2005-06 financial years using population alcohol-attributable fractions specific to the NT. Per capita consumption of pure alcohol, self-reported level of consumption, and age-standardised rates of death and hospitalisation attributable to alcohol. Apparent per capita consumption of pure alcohol for both Aboriginal and non-Aboriginal populations in the NT has been about 14 litres or more per year for many years, about 50% higher than for Australia as a whole. We estimated that there were 120 and 119 alcohol-attributable deaths in the NT in 2004-05 and 2005-06, respectively, at corresponding age-standardised rates of 7.2 and 7.8 per 10 000 adult population. Alcohol-attributable deaths occur in the NT at about 3.5 times the rate they do in Australia generally; rates in non-Aboriginal people were about double the national rate, while they were 9-10 times higher in Aboriginal people. There were 2319 and 2544 alcohol-attributable hospitalisations in the NT in 2004-05 and 2005-06, respectively, at corresponding rates of 146.6 and 157.7 per 10 000 population (more than twice the national rate). In recent years, alcohol consumption and consequent alcohol-attributable deaths and hospitalisations for both Aboriginal and non-Aboriginal people in the NT have occurred at levels far higher than elsewhere in Australia.

Australia, the healthiest nation: death, hospital and cost savings of the Preventative Health Taskforce target reductions for alcohol, 2007 to 2020

Background - The National Preventative Health Taskforce has set a 30% target reduction in the proportion of risky and high risk drinkers by 2020. This study estimated the potential saving in deaths, hospitalisations and associated economic cost savings to premature mortality and health of achieving the target. Method - Past national estimates of alcohol-attributable hospitalisations and deaths were used to forecast trends from 2007 to 2020. Estimated potential savings in deaths and hospitalisations were based on incremental decline in the prevalence of risky/high-risk drinking reaching a total of 30% by 2020 (about 2.3% per year). Associated economic costs of premature death were estimated using the Value of Statistical Life method (willingness to pay). Hospital costs were estimated from known trends in annual national costs for recent past years and taking inflation into account. Results - A 30% reduction in risky/high-risk drinkers would avoid an estimated 7,200 deaths and some 94,000 person-years-of-life lost due to premature death by 2020. The estimated benefit to the health sector would include 330,000 fewer hospitalisations and 1.5 million associated bed days. The net present value of these benefits is AUD 22.7 billion from deaths avoided and AUD 1.7 billion from fewer hospital separations totalling AUD 24.4 billion. Conclusion - The potential savings in premature deaths, health and associated financial costs of a 30% reduction in risky and high-risk drinking by 2020 across the Australian population are considerable.

Income inequality and alcohol attributable harm in Australia

BackgroundThere is little research on the relationship between key socioeconomic variables and alcohol related harms in Australia. The aim of this research was to examine the relationship between income inequality and the rates of alcohol-attributable hospitalisation and death at a local-area level in Australia.MethodWe conducted a cross sectional ecological analysis at a Local Government Area (LGA) level of associations between data on alcohol caused harms and income inequality data after adjusting for socioeconomic disadvantage and remoteness of LGAs.The main outcome measures used were matched rate ratios for four measures of alcohol caused harm; acute (primarily related to the short term consequences of drinking) and chronic (primarily related to the long term consequences of drinking) alcohol-attributable hospitalisation and acute and chronic alcohol-attributable death. Matching was undertaken using control conditions (non-alcohol-attributable) at an LGA level.ResultsA total of 885 alcohol-attributable deaths and 19467 alcohol-attributable hospitalisations across all LGAs were available for analysis. After weighting by the total number of cases in each LGA, the matched rate ratios of acute and chronic alcohol-attributable hospitalisation and chronic alcohol-attributable death were associated with the squared centred Gini coefficients of LGAs. This relationship was evident after adjusting for socioeconomic disadvantage and remoteness of LGAs. For both measures of hospitalisation the relationship was curvilinear; increases in income inequality were initially associated with declining rates of hospitalisation followed by large increases as the Gini coefficient increased beyond 0.15. The pattern for chronic alcohol-attributable death was similar, but without the initial decrease. There was no association between income inequality and acute alcohol-attributable death, probably due to the relatively small number of these types of death.ConclusionWe found a curvilinear relationship between income inequality and the rates of some types of alcohol-attributable hospitalisation and death at a local area level in Australia. While alcohol-attributable harms generally increased with increasing income inequality, alcohol-attributable hospitalisations actually showed the reverse relationship at low levels of income inequality. The curvilinear patterns we observed are inconsistent with monotonic trends found in previous research making our findings incompatible with previous explanations of the relationship between income inequality and health related harms.