Alcohol : a national concern NCEPOD: measuring the units Professor Martin Lombard
Alcohol related disease Alcohol related admissions (NI39) Trends 2002-2012 and beyond NHS 2,000,000 Public Health response to 1,800,000 Interventions Problems & 1,600,000 Admissions 1,400,000 1,200,000 ALCOHOL 1,000,000 800,000 600,000 400,000 Social 200,000 behaviours - & attitudes Public Policy & regulation
Pattern of deaths in England, by age, in 2007 Total: 500,000 deaths 100% Genitourinary 90% Other GI & Liver 80% RESPIRATORY Alcohol 70% Mental Endocrine 60% CIRCULATORY SUICIDE 50% Alcohol Alcohol 40% GI cancers ACCIDENTAL DEATH 30% Alcohol 20% ALL CANCERS 10% 0% < 1 01-04 05-09 10-14 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+ Source: ONS Death Deaths from mental disorders - For younger people (under 50) - these deaths are mostly people dying from mental/behavioural disorders associated with alcohol or drug use. For older people (over 50) these deaths are almost entirely due to dementia Registry
Liver mortality: „mind the gap‟ 2. International – Liver disease mortality trend dramatic increase relative to other major countries SDR, chronic liver disease and cirrhosis, 0-64 per 100000 France Italy England Source: WHO/Europe, European HFA Database, January 2012 1. England – rising 5% pa 1990’s, now 1.7% pa.
Chronic Liver Disease (1) Mortality - 1993 & 2009 Rates per 100,000 population North East • 5.7 up to 13.7 North West • 7.3 up to 15.2 Yorks & Humber • 4.8 up to 10.2 Rapid increase across the country in the last 16 years (1) Metric: Mortality from chronic liver disease including cirrhosis (ICD v10: K70, K73, K74) Source: National Centre for Health Outcomes Development (NCHOD), part of NHS Information Centre Data: SHA level data, standardised for age and gender using European Standard population. Figures are rates per 100,000 population.
1996-97 Mortality <75 yrs Community Liver Disease 1998-00 Trends 1996-2008 NW „Typical‟ GP pop 10,000 (<75yrs=9,210) 2001-03 Expect 88 deaths pa Mths 2004-06 4.5 2006-08 Age <75 dying per annum = 29 4 Lung Cancer: 2.8 Acute myocardial infarction: 1.6 3.5 Breast cancer: 1.8 3 Liver disease 2.2 2.5 Chronic liver disease 60 2 Established cirrhosis: 6.0 Hepatocellular cancer: 0.6 1.5 1 Dependent drinkers: 640 0.5 Risk cirrhosis from NASH: 250 Number with hepatitis C: 40+ 0 Number with hepatitis B: 30+ t g t g r r r r e e a n a n v e u v e u i L i H L H l L A A - - e e Total „at risk‟ 16 -75 years: M >10% M C C l l a a - m m M e l e Abnormal liver tests if checked: 10*20% e a F F m e F
Death due to ALD/Cirrhosis age 35-69 per 100,000 living in UK
Alcohol strategy • Individual responsibility • Local level policies & strategy • Taxation • 2% >rpi escalator • Min juice cider • rate for beer ABV>7.5% • Support EU changes for wine • Relationship with price • MUP (consult, propose 40p) • Ban multi-buy in off sales (consult) • Advertising: definite link, proportionate measures • Self regulation • Tighten rules esp <18 • Emerging issues: – Fraud, illegal alcohol – Liver strategy
Outcomes Framework Domains
NHS Ten steps to address Liver disease Test Conserve Assess Think Refer / Monitor LIVER Support Monitor / Patients & Review Carers & EOLC Rescue Treat events Surveillance for Complication
NHS aspects of alcohol strategy • PH to commission Identification & BIs • Alcohol liaison nurses in A&E • “Make every contact count” (www.liver.nhs.uk) • Health checks – identification (40-75 yrs) • Treatment – Addiction services – Prisons (NHSCB) – Mental health (strategy)
Thiamine vs. Combined Acamprosate and Disulfiram 4000 3500 3000 Thiamine Prescriptions 2500 PCT 2000 Linear (PCT) y = 0.3916x + 733.57 R² = 0.2515 1500 1000 500 0 0 1000 2000 3000 4000 5000 6000 Combined Acamprosate and Disulfiram Prescriptions
Alcohol related Liver Disease • Awareness & Education (Professional attitudes) • Use/Agree pathways/Test • Identify people at risk – Disperse expertise – Audit-C – Fibrosis markers – Trauma & violence – Follow up & repeat – Obesity & DM interventions – Join up services • Brief & extended interventions • Addiction services • Social services • Influence your • Resilience community & leaders • Change attitudes & behaviours!
ALCOHOL: whose problem is it? OURS!
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