A tale of two cities: Beverage purchasing and effects of minimum pricing among 600 heavy drinkers attending hospitals in Glasgow and Edinburgh

Transcription

1 A tale of two cities: Beverage purchasing and effects of minimum pricing among 600 heavy drinkers attending hospitals in Glasgow and Edinburgh Professor Jonathan Chick and Dr Jan Gill, Queen Margaret University Alcohol Research UK annual conference 2013

2 Predicted benefits of a 50p/unit min. price (Sheffield University: modelling based on previous national and international data)!!!!!!!!!overall Scottish consumption by 7.2%! Scottish hospital admissions by 8, years total societal cost (crime, health, by 1.3 billion)

3 Affordability! increased by 45% from (nb rising disposable income)!! Source: MESAS, 2012

4 Evaluating effects of minimal pricing on health Sales data Hospital discharge data/ mortality data General population surveys (but heavy drinkers under-represented) Monitor possible unwanted effects: dependent drinkers: substitute alcohols/other drugs/stealing/ smuggling/illicit distilling?

5 Inclusion criteria Attending an alcohol problems service out-patient appointment Or Admitted to hospital, and having a diagnosis of an alcohol-related condition (whether or not another diagnosis has also been made)!

6 Under 16 years old; Exclusion Unable to understand the questions or give understandable answers in English Clinically significant memory impairment e.g. Korsakov's dementia Unwilling to be contacted for 3 further follow-up interviews.

7 Alcohol drunk and price paid Drinks questionnaire ; last 7 days of last period of drinking using the Time Line Follow- Back method (beverage, volume purchased, cost and location (off/on/free/ home brewed etc) of purchase for each day. From this, and using manufacturer s data, the price per unit (8 gram) of ethanol was calculated.

8 Alcohol related problems questionnaire (ARPQ)

9 Some preliminary findings 1 Drinking, purchasing and harms among sick drinkers 2 Between-city differences 3 Determinants of inequalities in harms 4 Purchasing during era of decreasing affordability!

10 BASELINE DATA: Current study (Glas +Edin) >! Pilot study (Edin 2008/9) Black et al 2010 Addic&on!106,!! N % male Mean Age (years) ( range) Consumption (typical or last week) mean units (95%CI) 46 (18-79) 215 ( ) Median Unit price (pence) 40p (14 145) ( ) 37p (9-140) % of all units bought as OFF sales

11 The more that s drunk, the more harms r! p! All! 0.357! 0.01! Male! 0.326! 0.01! Female! 0.459! 0.01!

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14 The Glasgow Effect Reduced life expectancy in Glasgow (e.g. males 5.4 years lower than in Edinburgh in 2001) Relates to social deprivation, and is particularly accounted for by suicide, drug deaths and alcohol liver disease Leyland et al

15 Between city differences : causes of problems SES is more predictive of ARPQ in Edinburgh (OR 0.9, p<.001) than Glasgow (OR 0.6, n.s.) Consumption is more predictive of ARPQ in Edin than Glasgow i.e. Is there is something else in Glasgow, in addition to low SES, that contributes to problems, especially mental health problems.. A Glasgow effect?!

16 Between city differences: Source Purchasing from Independent outlets) ( corner shops ) predicted problems in Edinburgh, not Glasgow ; but MUCH commoner in Glasgow

17 Social economic class (SES) inequalities (2) Mental health problems (OR 1.97,p<.001), not liver problems (OR 1.12, n.s)., linked to lower SES SES not a predictor of health problems among women (viz: Females were more likely than men to be from higher SES - OR 0.62, p<.05)

18 In the wider population, sales follow affordability!! Source: MESAS, 2012

19 % of all off-sales units purchased at or below 50 pence/unit 2008/9! 2011/12! Glasgow!pa9ents! 80%! Edinburgh!pa9ents!! Wider!Scotland! (Health!Scotland,!2012)! 83%! 77%! 81%! 66%!!

20 i.e. moderate drinkers are following their preferred beverages into a higher price range, and overall are reducing consumption;...while very heavy drinkers stay purchasing cheaply for as long as they can. Patients are resisting the current downward trend in affordability, because the cheap alcohol is still there.

21 The proportion of their consumption that patients buy at less than 50p/unit has INCREASED while affordability has fallen...because those purchases (those products!) are still available

22 Cheap cider and sick drinkers

23 Future work Linkage with NHS hospital and with Deaths Register (nb 22 deaths already documented in in first 3 months of recontacting) Trends in drink purchasing against background UK economic changes (incl benefits) and marketing fashions Profiling the drinker resistant to treatments/ and changes in the sourcing of alcoholic beverages in the UK??effects of MUP

24 Heather Black - Leading RA; conducted the Pilot Robert Rush (statistician) Fiona O May (research fellow) Christine Galloway, Shauna Kielty (RAs Edinburgh) Cheryl Rees and Jane Doogan (RAs Glasgow) Prof Barbara McPake (economist) Lucie Michalova (coordinator) Rebecca Lawrence, Helen Leslie (Edinburgh) Iain Smith, George Benson, Ewan Forrest, Frances Skelton (Glasgow)!!

25 Week s consumption (Mean)!! Scottish general population (Adults 16 years or older) from sales data: 23.5 units from Scottish Health Survey: 11.6 units Our sample units

26 Glasgow! Edinburgh! p! Mean!weekly! consump9on!! 228.4!!(95%CI! 212.4Q244.4)! 199.4! (95%CI! 185.4Q213.4)! 0.009! males! females! Mean!weekly! consump9on!! 228.2! (95%CI!=! 215.1Q241.3)! 180.4! (95%CI!=! 162.3Q198.5)! <0.001!

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30 The White Cider drinkers Greater!propor9on!of! males!in!this!group!than! non!!white!cider!drinkers,!p! =!0.014).! But!no!differences! between!the!ci9es!in! gender!distribu9on!of! white!cider!drinkers.!

31 Range!10Q!29!pence! per!unit!

32 Comparison with other dependent drinkers White cider drinkers Other dependent drinkers p N Mean age (95%CI) 40.3 ( ) Median ARPQ (IQR) 7.7 (3.0) Mean Consumption (typical or last week) UK units (95%CI) Mean Unit price (pence) (95% CI) Mean Expenditure per week ( ) (95% CI) ( ) 23.9 ( ) ( ) Mean cigarettes/day 14.4 ( ) 47.5 ( ) 6.0 (3.5) ( ) 50.2 ( ) ( ) 12.5 ( ) n.s.

33 Scottish general population: Trend towards less sales at below 50ppu In 2008, 81% of all off-trade alcohol was sold at less than 50ppu, falling to 66% in At the upper end of the price distribution, 95% of all off-trade alcohol was sold at less than 70ppu in 2008, falling to 91% in For instance, there was a 22% point decrease between 2008 and 2011 in the proportion of alcohol sold at less than 40ppu, compared with only a 4% point drop in the proportion sold at below 70ppu. But the proportion that patients are buying at that level has INCREASED not decreased...because those purchases can still be made. There are fewer products at 9p/unit, but still 14p/unit