Public Health Intelligence Section Preston Primary Care Trust. April 05

Transcription

1 Alcohol-related death rates in Preston Local Authority and Preston Primary Care Trust, 2001 to 2004 Farha Abbas, Public Health Research & Intelligence Analyst Jonathan Peters, Public Health Information Analyst James Mechan, Head of Public Health Intelligence Public Health Intelligence Section Preston Primary Care Trust April 05

2 Background Alcohol is the most potent mood altering addictive drug that is legal to buy and use; comparatively cheap and readily available in the UK. Millions of people throughout the UK enjoy drinking alcohol to socialise and relax. However, at a wider level, alcohol-related diseases, mortality and crime are contributing to inequalities, reducing life expectancy, disrupting local communities and hampering efforts for economic growth. The burden of alcohol-related harm that falls on the North West is disproportionately high, in comparison to other English regions (Hughes, 2004). North West has among the highest levels of alcohol consumption in the country and, correspondingly, among the highest rates of alcohol-related mortality (Hughes, 2004). For all types of alcohol-related harm, including cancers, cardiovascular diseases and cirrhosis of the liver, the more an individual drinks, the greater the risk of harm (Alcohol Concern, 1998). People in the UK consume a lot of alcohol but people in the North West appear to consume considerably more alcohol than the English Average. A recent report by the Office for National Statistics (ONS) showed that alcohol-related death rate in the North West is considerably higher than the national average for England; in fact North West has the highest alcohol-related male and female death rate in England (ONS, March 2005). As far as Local Authorities are concerned, rates, from the ONS, reveal that Preston Local Authority has the fifth highest alcohol-related death rate amongst males (ONS, March 2005). Following on from the March 2005 report by the ONS, this brief report has been compiled to: Identify possible trends in alcohol-related deaths in Preston Local Authority and Primary Care Trust (PCT) between 2001 and 2004 Identify possible signs of decline in alcohol-related death rates, by comparison of rates with ONS rates Present an in-depth (ward level) analysis of alcohol-related deaths in Preston Local Authority and Preston Primary Care Trust (PCT). Data collection Alcohol contributes to a whole range of health conditions; however, information on the contribution of alcohol to specific health conditions is not routinely collected nationally or at a Preston level. Much of the available knowledge about alcohol and health is taken from research studies and many of these are not specific to Preston. Data on mortality from alcohol-related conditions are collated by ONS. ONS definitions are broad and include all deaths due to alcohol poisoning as well as dependent and non-dependent abuse of alcohol. However, the definition does not include all deaths from accidents, suicide or assault where alcohol was involved. For example, deaths due to drink-driving will be classified as road traffic accidents; suicides involving drugs and alcohol will usually be classified as drug related deaths; and fights in pubs resulting in death will be classified as assault. Alcohol-related 1

3 In addition, there are many other causes of liver cirrhosis, unrelated to alcohol, including a side effect of medication or infections such as hepatitis B and C. Estimates of the annual total number of deaths in which alcohol has played a role can therefore vary widely depending on the criteria used. The definition used by ONS allows for consistent comparisons over time for those deaths where a clear association with alcohol consumption can generally be assumed. ONS selected alcohol-related deaths using the International Classification of Diseases Tenth Revision (ICD-10). Table 1 lists the categories included in the ONS definition of alcohol-related deaths and used by ONS. ICD-10 Code Description F10 Mental and behavioural disorders due to use of alcohol I42.6 Alcoholic cardiomyopathy K70 Alcoholic liver disease K73 Chronic hepatitis, not elsewhere classified K74 Fibrosis and cirrhosis of liver X45 Accidental poisoning by and exposure to alcohol Table 1: The categories included in the ONS definition of alcohol-related deaths (ONS, March 2005) Alcohol-related deaths include those causes regarded as most directly due to alcohol consumption. Apart from deaths due to accidental poisoning with alcohol, this excludes external causes of death, such as road traffic deaths & other accidents, & alcohol-related suicides & homicides. To compile a local picture of alcohol related deaths in Preston Local Authority and PCT, the number of alcohol related deaths occurring between 2001 and 2004 were obtained from the 2004 Public Health Mortality Files (PHMFs) and ONS Death Extracts (2001, 2002 and 2003). The ICD10 codes used to extract the number of alcohol-related deaths across Preston Local Authority and PCT between 2001 and 2004 were the same as those utilised by ONS (table 1). Trends in alcohol-related deaths in England and Wales from 1979 to 2000 were published in an article in Health Statistics Quarterly (HSQ) 17 in This article lists the International Classification of Diseases (ICD) codes used in the ONS definition of alcohol-related deaths. From 1979 to 2000 deaths were coded using the Ninth Revision of the ICD (ICD-9). From 2001 deaths have been coded using the Tenth Revision (ICD-10). Rates from 2001 are not directly comparable with those for earlier years because of the change from ICD-9 to ICD-10 (ONS, March 05) Within this report, the 2002 to 2004 pooled rates presented for Preston Local Authority are age-standardised using the European Standard Population. Alcohol-related 2

4 ONS rates, National, Regional and Local level National The number of alcohol-related deaths in England and Wales, which rose throughout the 1980s and 1990s, has continued to rise in more recent years. Numbers increased from 5,970 in 2001 to 6,580 in Death rates per 100,000 population also increased, from 10.7 in 2001 to 11.6 in 2003 (ONS, 2005). Alcohol-related deaths are much more common for males than females. In 2003 males accounted for almost two thirds of the total number of deaths. The male death rate, at 15.8 deaths per 100,000 population, was twice the rate for females (7.6 deaths per 100,000 population). Regional The 2001 to 2003 data (ONS, 2005) highlights wide regional variations in rates of alcohol related deaths with there being were very different rates of alcohol-related deaths in the English regions and Wales in 2001 to The highest rates were found in the North West and North East and the lowest ones in the East of England, South West and South East (figure 1). The rate for the North West was almost double that for the East of England (15.1 and 7.7 deaths per 100,000 population respectively). The West Midlands, London and Wales also had rates which were above the average for England and Wales. Figure 1: Alcohol-related death rates, by Government Office Region in England and Wales, 2001 to 2003 (Source: ONS, 2005) Local Of the ten Local Authorities with the highest alcohol-related death rates for males, five were in the North West, with the highest in Blackpool and the fifth highest (out Alcohol-related 3

5 of the ten highest) in Preston. The rate in Blackpool was 43.9 deaths per 100,000 population, almost three times the national average. The rate in Preston was 29.5, almost twice the national average (table 2a). Out of the ten Local Authorities with the highest female death rates, six were in the North West; Blackpool was the second highest, however, Preston was not amongst the 10 Local authorities with the highest female death rate related to alcohol. Nonetheless, the rate in Preston was nearly 1.8 times higher than the national average (table 2a). The highest rate for females was in Corby in the East Midlands (20.3 deaths per 100,000 population), almost three times the national average. As presented in table 2a, alcohol related death rate ( ) amongst Preston Local Authority males, females and all people is higher than the average for England and Wales and North West Government Office Region (GOR). Area Rate per 100,000 population All people Males Females England & Wales North West GOR Preston Local Authority Table 2a: Alcohol-related death rates, (Source: ONS, 03/03/2005). Rates per 100,000 population standardised to the European Standard Population alcohol related death rates produced by the ONS (March 2005) are not calculated for the Primary Care Trusts. It should be noted that as Preston PCT boundaries also cover areas of Ribble Valley as well Preston Local Authority the values for Preston Local Authority cannot be substituted for Preston PCT. Alcohol- related death rates ( pooled), by Preston Local Authority The rates presented are death rates per 100,000 population that have been age standardised using the European Standard population. The rates are based on deaths of usual residents of Preston Local Authority; the number of deaths have been pooled for the period 2002 to 2004, based on deaths occurring in each calendar year. The pooled data (presented in table 2b) show that the alcohol-related death rate amongst all people and males in Preston Local Authority is lower than the pooled rate (table 2a). Based on the alcohol-related death rates for and , it may be speculated that a lower death rate (amongst all people and males) may be attributable to a decline in alcohol related deaths in 2004 (table 3). It should, however, be noted that although the data presented in table 3 relates to Preston PCT, it is assumed that the trend would be similar for Preston Local Authority as majority of deaths relate to Preston Local Authority and not Ribble Valley area of Preston Alcohol-related 4

6 PCT. The percentage of total deaths between is significantly higher in Preston Local Authority part of Preston PCT than the Ribble Valley area covered by the PCT. Therefore, any trends identified from table 3 will also be applicable to Preston Local Authority. The alcohol-related female death rate amongst Preston Local Authority is slightly higher than the female death rate (13.81 vs. 13.1, tables 2a and 2b); this may be due to a number of reasons including: The decline in the number of alcohol-related deaths in 2004 is greater amongst the males than the females; i.e., the decline in 2004, from 2003, was greater amongst the males than females (table 3). The increase in number of deaths in 2003, from 2002, was greater amongst females than males thus although the male deaths rate has declined the female rate has not. Table 2b also shows that the alcohol-related death rate ( ) across Preston PCT is slightly lower than the Preston Local Authority death rate ( ); this may be attributable to a low percentage of deaths taking place in the parts of Ribble Valley covered by Preston PCT, in comparison to Preston Local Authority wards. Therefore, alcohol-related death rates across Preston PCT are diluted by a lower number of deaths in the areas of Ribble Valley covered by Preston PCT. Area Preston Local Authority Rate per 100,000 population All people Males Females *Preston PCT *18.03 *24.55 *11.56 Table 2b: Alcohol-related death rates, 2002 to 2004 pooled. Rates per 100,000 population standardised to the European Standard Population * death rates. Alcohol related crude deaths, In an attempt to determine an alcohol related death rate across Preston Local Authority and Preston PCT (for the period ), mortality data were analysed from the 2004 PHMFs and 2001, 2002 and 2003 ONS Death Extracts. The alcohol-related death rates for Preston Local Authority, PCT, and wards are crude death rates per 100,000 population and are not agestandardised using the European Standard Population. Alcohol related crude deaths, pooled Between 2001 and 2004, among Preston PCT residents, there were 101 deaths directly attributable to alcohol (67% males (n=68) and 33% females (n=33)). The Alcohol-related 5

7 number of alcohol-related deaths were higher amongst the males than females. As shown in figure 2, in males and females, the highest proportion of alcoholrelated deaths were attributable to alcoholic liver disease (K70-44 in males and 18 in females). Fibrosis and Cirrhosis (K74) was the second highest cause of death in both males and females (15 males, 14 females). % of total alcohol related deaths in Preston PCT ( pooled) Percentage Male Female F10 I42.6 K70 K73 K74 X45 ICD10 Code Figure 2: Percentage of total alcohol related deaths between 2001 to 2004 pooled (Source: 2004 PHFMs and 2001, 2002, 2003 ONS Death Extracts) Trend between 2001 to 2004 (single years) Preston PCT Annual comparisons presented in table 3 show that, in comparison to 2001 and 2002, in 2003 there was an increase in the total number of alcohol related deaths. The increase in 2003 was mainly attributable to the rise in deaths amongst the females which was greater than that in males, in comparison to the latter years (table 3 and figure 3). However, the total number of deaths related to alcohol (in both males and females) seems to have declined in 2004, in comparison to 2001, 2002 and Year Male Female Grand Total Grand Total Table 3: Number of alcohol related deaths per year across Preston PCT between 2001 and 2004 (Source: 2004 PHMFs and 2001, 2002, 2003 ONS Death Extracts). Alcohol-related 6

8 Alcohol related deaths by sex and year for Preston PCT, Number of alcohol related deaths Male Female Year Figure 3: Number of alcohol related deaths per year across Preston PCT between 2001 and 2004 (Source: 2004 PHMF and 2001, 2002, 2003 ONS Death Extracts). Alcohol-related crude death rate by ward, pooled As presented in table 4, in males, females and all people, the overall crude rate (Rate per 100,000 population) of alcohol related deaths across Preston PCT is slightly lower than that for Preston Local Authority. The figures show that the alcohol-related death rate in Preston PCT is over two times higher in males in comparison to females; in males in females. The alcoholrelated death rate amongst all people in Preston PCT is (table 4). As presented in table 4, the rates also highlight a considerably wide ward level variation in alcohol-related death rates in Preston PCT, with death rate ranging from (in Ribbleton) to 0.00 (some of the least deprived wards in Preston PCT). Wards with the five highest alcohol-related crude death rates (in all people) are: (i) Ribbleton (47.70) (ii) Town Centre (41.25) (iii) Moor Park (35.73) (iv) St George s (34.65) (v) St Matthew s (30.96) Alcohol-related 7

9 It should be noted that the alcohol-related death rate (amongst all people) in all of the above mentioned wards is higher than the average for all people in Preston PCT and Local Authority. Wards with the five highest alcohol-related crude death rates (in males) are: (i) Town Centre (65.45) (ii) Ribbleton (56.34) (iii) Moor Park (53.46) (iv) Deepdale (52.36) (v) Brookfield (49.25) It should be noted that the alcohol-related death rate (amongst males) in all five of the above mentioned wards is higher than the average rate for Preston PCT and Local Authority males (figure 4). Wards with the five highest alcohol-related crude death rates (in females) are: (i) Ribbleton (39.61) (ii) St George s (29.67) (iii) Tulketh (28.02) (iv) Larches (25.83) (v) Cadley (20.37) It should be noted that the alcohol-related death rate (amongst females) in all of the above mentioned wards is higher than the average rate for Preston PCT and Local Authority females (figure 4). Alcohol-related 8

10 Ward Rate per population 100,000 population Female Male All People Ashton Brookfield Cadley College Deepdale Fishwick Garrison Greyfriars Ingol Larches Lea Moor Park Preston Rural East Preston Rural North Ribbleton Riversway St. George's St. Matthew's Sharoe Green Town Centre Tulketh University Aighton Bailey and Chaigley Alston and Hothersall Chipping Derby and Thornley Dilworth Ribchester PCT Total Preston City Table 4: Crude rate (per 100,000 population) of alcohol-related deaths between 2001 to 2004 pooled, by ward (Source: 2001, 2002, 2003 ONS Death extract and 2004 PHMFs) Alcohol-related 9

11 Crude rate of alcohol-related deaths ( ) by ward Crude rate per 100,000 population Male Female 0.00 Ashton Brookfield Cadley College Deepdale Fishwick Garrison Greyfriars Ingol Larches Lea Moor Park Preston Rural East Riversway Ribbleton Preston Rural North Ward St. George's St. Matthew's Sharoe Green Town Centre Tulketh University Aighton Bailey and Chaigley Alston and Hothersall Chipping Derby and Thornley Dilworth Ribchester PCT Total Preston City Figure 4: Crude rate (per 100,000 population) of alcohol-related deaths, 2001 to 2004 pooled, by ward (Source: 2001, 2002, 2003 ONS Death extract and 2004 PHMFs) Alcohol-related death and deprivation of ward of residence The rank of the Index of Multiple Deprivation (IMD) 2004 (of each ward was used to determine any association between deprivation of the ward of residence and alcohol-related death rate (where 1 is the most deprived - Source: Office of the Deputy Prime Minister, Indices of Deprivation 2004). Alcohol related deaths amongst all people The ward of residence was ranked in terms of its national IMD2004 rank, and plotted alongside the ward standardised alcohol-related death rate. The ward standardised alcohol-related death rate was calculated using ward population numbers from the 2001 Census (figures 5, 6 and 7). The findings show a correlation (Correlation coefficient (r) =-0.85) between the rank of IMD2004 of the ward and alcohol-related death rate amongst all people (figure 5). The Correlation coefficient of indicates a strong association between deprivation and alcohol-related death rate amongst all people. Please note that the correlation coefficient is a negative value because the higher the rank of IMD2004 Alcohol-related 10

12 the less deprived a ward (1 is the most deprived). For any strong association between death rate and deprivation the death rate will be high and IMD2004 rank low (thus negative r value). Alcohol related deaths amongst males The ward of residence was ranked in terms of its national deprivation rank, and plotted alongside the ward standardised alcohol-related death rate amongst males which was calculated using ward population numbers from the 2001 Census (figures 6). The findings show a correlation (Correlation coefficient (r)=- 0.83) between the rank of IMD2004 of the ward and alcohol-related death rate amongst males (figure 6). The Correlation coefficient of 0.83 indicates a strong association between deprivation and alcohol-related death rate amongst males Alcohol related deaths amongst females The ward of residence was ranked in terms of its national deprivation rank, and plotted alongside the ward standardised alcohol-related death rate amongst females which was calculated using ward population numbers from the 2001 Census (figures 7). The findings show a correlation (Correlation coefficient (r) = 0.53) between the rank of IMD2004 of the ward and alcohol-related death rate amongst females (figure 7). This Correlation coefficient is not as high as that for males and all people, however it does indicate some degree of association between deprivation and alcohol-related death rate amongst females. The association between female alcohol-related deaths and deprivation of ward of residence is not as strong as it is between male alcohol-related deaths and deprivation of ward of residence; this is quite evident from figures 6 and 7. The data also showed that it is not always the most deprived wards in Preston that are affected by higher alcohol-related death rate amongst the females. For example alcohol-related death rate amongst females in the wards of Cadley and Derby and Thornley, which are amongst the less deprived wards, is higher than the death rate in some of the deprived wards in Preston (figure 8). Alcohol-related 11

13 Alcohol-related crude death rate ( ) in all people, by IMD2004 rank of ward Crude rate per 100,000 population Ribchester Dilworth Greyfriars Preston Rural East Alston and Hothersall Garrison Preston Rural North Sharoe Green Cadley Chipping Derby and Thornley Lea Aighton Bailey and Chaigley College Tulketh Ashton Larches Riversway Ingol University Moor Park Brookfield Town Centre Fishwick Deepdale St. George's Ribbleton St. Matthew's Ward least deprived Most deprived Figure 5: Crude rates of alcohol related deaths amongst all people, by ward of residence (ranked in order of rank of IMD 2004) (Source: Public Health Mortality File and Office for National Statistics). Alcohol-related crude death rate ( ) amongst males, by rank of IMD2004 rank of ward Ribchester Dilworth Greyfriars Preston Rural East Alston and Hothersall Garrison Preston Rural North Sharoe Green Cadley Chipping Derby and Thornley Lea Aighton Bailey and Chaigley College Tulketh Ashton Larches Riversway Ingol University Moor Park Brookfield Town Centre Fishwick Deepdale St. George's Ribbleton St. Matthew's Crude death rate per 100,000 population Ward Most deprived least deprived Figure 6: Crude rate of alcohol related deaths amongst males, by ward of residence (ranked in order of rank of IMD2004) (Source: Public Health Mortality File and Office for National Statistics). Alcohol-related 12

14 Alcohol-related crude death rate ( ) amongst females, by rank of IMD2004 rank of ward Crude death rate per 100, 000 population Most deprived St. Matthew's Ribbleton St. George's Deepdale Fishwick Town Centre Brookfield Moor Park University Ingol Riversway Larches College Tulketh Ashton Ward Aighton Bailey and Chaigley Lea Derby and Thornley Chipping Cadley Sharoe Green Preston Rural North Garrison Alston and Hothersall Preston Rural East Greyfriars Dilworth least deprived Ribchester Figure 7: Crude rate of alcohol related deaths amongst females, by ward of residence (ranked in order of rank of IMD2004) (Source: Public Health Mortality File and Office for National Statistics). Alcohol-related crude death rate by age, pooled, by Preston PCT Across Preston PCT, amongst all people, approximately 32% of deaths are among those aged 50-59, and 20% among those aged and 17% of deaths among those aged Amongst males, approximately 24% of deaths are among those aged 50-59, and 12% among those aged and 12% of deaths among those aged These findings highlight that amongst males the percentage of alcohol-related deaths are highest in the age group (figure 8). Among females, the percentage of total alcohol-related deaths are spread over the age bands thus making it quite difficult to deduct an age band (without further expanding the age bands) that has the highest percentage of mortalities (figure 8). Amongst females approximately 16% of deaths are among those aged (8% in and 8% in 50-59). These data indicate that in females the and age groups have the highest percentage of alcohol-related deaths; however, the percentage of deaths in these age groups in females is lower than that in these age groups in the males. Alcohol-related 13

15 Alcohol-related deaths ( ), by age and sex Percentage of total deaths Male Female to to to to to to to to to Age group (years) Figure 8: Alcohol-related deaths ( ) by age and sex (Source: 2004 PHMFs and 2001, 2002 & 2003 ONS Death extracts) Alcohol-related deaths by time of year, pooled, by Preston PCT The percentage of alcohol-related deaths according to the time of year of death were analysed to identify an association between alcohol-related mortality and the time of year of occurrence. As it can be seen from figure 9, the 2001 to 2004 pooled data do not highlight any apparent time of year when the mortality from alcohol-related deaths may be higher. Approximately 55% of the total deaths occurred in the first six months of the year. Alcohol-related 14

16 Percentage of total alcohol-related deaths by time of year, , Preston PCT Percentage December November October September August July June May April March February January Month Figure 9: Percentage of total alcohol-related deaths in Preston PCT( ) by time of year (Source: 2004 PHMFs & 2000, 2001, 2003 ONS Death Extracts) Discussion The higher alcohol related death rates amongst the males in North West may be related to the fact they are reported to consume more alcohol than the English average consumption amongst males. Males in the North West report that they consume 19.3 units of alcohol per week, higher than the English average of 18.0 units per week and second only to Northern and Yorkshire where men consume an average of 21.1 units per week (Alcohol & Health, NWPHO). On average men consume more alcohol than women, but women s overall consumption, as well as women s use of alcohol above recommended limits appears to be increasing faster than men s (Department of Health, 1999). Similar to the national pattern, in Preston Local Authority, and Preston PCT, alcohol-related deaths are much more common for males than females. The alcohol-related male death rate in Preston Local Authority was almost twice that for females. The male death rate in Preston PCT was twice that for females. Alcohol-related death rate is slightly lower than that in Preston Local Authority to 2004 mortality data show a general decline in alcohol related deaths in 2004, in Preston PCT. Although the ONS figures show Preston Local Authority to have the fifth highest nationally alcohol-related death rate amongst males, the data analysed in-house highlights a decline in death rate, in comparison to Therefore, it may be speculated that when 2004 mortality data is taken into account male alcohol-related death rate in Preston Local Authority may not rank as high nationally as it did for the data. However, figures Alcohol-related 15

17 show alcohol-related death rate amongst the females to be higher than that for the years The findings of this report also demonstrate an association between alcohol-related death and the national rank of deprivation of ward of residence; with alcohol-related deaths (amongst all people and males) being generally higher in the most deprived wards of Preston. References Alcohol Concern (1998). Fact Sheet 38. Damage to Health: Long Term Effect of Alcohol. Hughes, K., Tocque, K., Humphrey, G & Bellis, M (Sept. 2004). Taking Measures: A situational analysis of Alchohol in the North west. Public Health North West. Office for National Statistics website (March 2005). Alcohol-related Deaths: Rates continue to rise (Website) Office for National Statistics. Wide regional variation in alcohol-related death rates. 3 March Alcohol and Health. North west Public Health Observatory. Department of Health (1999). Statistics on alcohol: onwards. Statistical Bulletin 199/24 October. Alcohol-related 16