To support the free and open dissemination of research findings and information on alcoholism and alcohol-related problems. To encourage open access to peer-reviewed articles free for all to view.

For full versions of posted research articles readers are encouraged to email requests for "electronic reprints" (text file, PDF files, FAX copies) to the corresponding or lead author, who is highlighted in the posting.


Monday, February 20, 2012

Projections of alcohol-related deaths in England and Wales—tragic toll or potential prize?

The latest alcohol-related harm statistics from the UK's Office of National Statistics (ONS) were released on Jan 26, 2012,1 and provide an opportunity to re-evaluate the projections of alcohol-related liver deaths that we previously reported in this journal with 2008 data.2 Using the standard ONS definition,3 alcohol-related liver deaths in England and Wales fell from 6470 in 2008 to 6230 in 2009, but then increased again to 6317 in 2010.4 These data do not include the wider spectrum of alcohol attributable mortality, which would also include acute deaths from accidents, violence, and suicide or from chronic diseases, such as hypertension, stroke, cardiovascular disease, and cancers of the breast and gastrointestinal tract. Alcohol-related liver deaths thus account for around a quarter of total alcohol-related deaths.5

We postulated that a reasonable target for alcohol-related liver deaths would be 2500 per year, equivalent to the age-standardised mortality rate in the Netherlands, Sweden, Australia, New Zealand, and Norway, and outlined alternative scenarios whereby a more effective alcohol policy could be expected to reduce liver death rates.2 Our projection indicated that over 20 years the best possible policy scenario (green projection) estimated a cumulative 73 000 alcohol-related liver deaths, with the worst case scenario of an unchanged alcohol policy (black projection) leading to around 150 000 alcohol-related liver deaths. The difference between these two scenarios represented the avoidable deaths—around 77 000 deaths from liver disease, equivalent to perhaps a quarter of a million potentially avoidable deaths from the wider spectrum of alcohol-related harm.

To update our projections we took the line of best fit for the period 2003—10 and extrapolated this together with the prediction intervals (figure). Our updated estimates predict a cumulative total of around 143 000 alcohol-related liver deaths over the following 20 years, representing around 70 000 avoidable alcohol-related liver deaths compared with the best possible scenario (green projection). This is a moderate improvement from our previous projections2 and translates into around 210 000 avoidable alcohol-related deaths overall. We extrapolated from a relatively short time period to capture changes in mortality and as a result the prediction intervals are quite wide, for alcohol-related liver deaths a cumulative total of 128 000 to 162 000. The actual mortality over 20 years will not be determined by our modelling but by the effectiveness or otherwise of government alcohol policy. Unfortunately, the recent moderate improvement might be related more to the recession than to current alcohol policy; the fact that deaths increased during 2009—10 indicates there is no room for complacency. > > > > Read More