Director of Public Health Annual Report 2019: Alcohol and us

Alcohol has been identified as a contributing factor for more than 200 health conditions and injuries, including cancer, heart disease, stroke, high blood pressure, cirrhosis of the liver, poor sleep, lowered immunity and susceptibility to infections, mental health and memory problems, and depression. In England, alcohol misuse is the biggest risk factor contributing to early death, poor health and disability for people aged 15 to 49 years old. In terms of the harms to health, there is no safe level of alcohol consumption and the harms increase with the amount of alcohol consumed.

The health harms due to alcohol vary according to a number of factors including a person’s age, gender and body mass index (BMI), but also the pattern of their drinking, the volume of alcohol they drink and the length of time they have been drinking.

For a given level of alcohol consumption some groups of people are more vulnerable to the harms of alcohol. These groups include children and young people, women, older people and from lower socio-economic groups. Unborn babies are also at risk of harm from their mothers’ drinking, which can have profound effects on their development and lifelong health.

Children are particularly vulnerable to the effects of alcohol and, if they drink, may be more at risk of developing alcohol-related problems when they are older.

The Chief Medical Officer in England advises parents and carers that an alcohol free childhood is the healthiest and best option. There are risks associated with drinking alcohol for teenagers, including impacting their learning skills and long-term memory.

Overall women are more vulnerable to the ill effects of higher risk drinking levels. For example, women are twice as likely to die of liver cirrhosis (damage) when drinking the same amount as men.

As we age our bodies become less effective at processing alcohol. This means older people may have higher blood alcohol concentrations even if they drink the same amount as a younger person.

Therefore, when older people drink within the recommended lower risk guidelines, they may be over-drinking. There is very little research on alcohol and older people. Alcohol slows the brain’s function to a greater extent in older people, impairing coordination and memory, and raising the likelihood of incontinence, hypothermia, accidents and self-neglect. Drinking alcohol while taking certain medications can also result in harmful side effects.

As a result, older people are being admitted to hospital due to alcohol more frequently than before. Between 2008/09 and 2017/18, the rate of alcohol-related admissions in Buckinghamshire for people over 65 years old increased by 15.6%. This is slightly higher than England, which had a 13.9% increase for this age group. People over 65 years old have the highest rate of alcohol-related admissions in Buckinghamshire.

As separate behaviours alcohol consumption and smoking increase the risk of getting cancer and other illnesses, but smoking and drinking together increases the risk of developing illnesses to a greater extent than either behaviour alone. Obesity can also amplify the harmful impact of alcohol consumption on the liver. For a person with a body mass index greater than 35, the risk of harm to the liver doubles at any given alcohol intake. A similar synergistic effect is seen for smoking, alcohol and risk of stroke.

People who are less affluent often report lower levels of alcohol consumption. However, they experience greater levels of alcohol- related harm (e.g. liver disease) and appear to be more susceptible to the harmful effects of alcohol. Less affluent people are more likely to die or suffer from a disease relating to their alcohol use. In England, death rates from alcohol-related causes and alcohol-related liver disease increase as levels of deprivation increase.

This is known as the ‘alcohol harm paradox’ where disadvantaged populations who drink the same or lower levels of alcohol, experience greater alcohol-related harm than more affluent populations. The reasons for this paradox are not clear but could include different drinking patterns in different groups, lower resilience and/or compounding effects with other risk factors, e.g. smoking, health conditions or different use of health services.

Alcohol misuse increases the risk of poor physical and mental health.

Alcohol increases the risk of developing several types of cancer, including breast and bowel cancer, cancers of the mouth and throat, oesophagus, liver, stomach, pancreas, lung and gallbladder. For certain cancers, including breast cancer, any level of drinking increases your risk so there is no ‘safe’ level of drinking. It has been reported that just one extra drink a day increases your risk of breast cancer by 10%.

Alcoholic liver disease includes fatty liver disease, alcoholic hepatitis and cirrhosis. Death rates from alcoholic liver disease have increased 400% since 1970, and in people younger than 65 years have risen by almost five times. In Buckinghamshire, the rate of hospital admissions due to alcoholic liver disease increased between 2008/09 and 2017/19 by 87.4% (38.2 to 71.6 per 100,000). This is almost double the increase over the same time period in England (47.8% increase).

Broadly speaking, high blood pressure increases in line with the amount of alcohol consumed, and high levels of alcohol consumption increase the risk of stroke and heart disease. Binge drinking is also a risk factor for atrial fibrillation, which is characterised by an irregular heartbeat.

Again, while alcohol consumption and smoking as isolated behaviours both increase the risk of stroke, people who smoke and drink alcohol increases the risk to a greater extent than either behaviour alone.

Drinking can affect people’s sleep by disrupting sleep patterns and affecting their quality of sleep. It also reduces people’s immunity to infection. For example, the risk of pneumonia increases with increasing alcohol consumption. People with high levels of drinking or alcohol dependence are eight times more likely to develop pneumonia.

Drinking alcohol can affect judgement and behaviour and memory loss can also be a problem during drinking and in the long term for regular heavy drinkers.

Alcohol is linked to a range of mental health issues including aggression, anger, depression, memory loss and suicide. In England, people who have anxiety or depression are twice as likely to drink heavily as those without depression or anxiety.

Current research suggests alcohol use disorders increase the risk of depression, suicidal thoughts, attempted suicide and completed suicide. The rate of hospital admissions for mental and behavioural disorders due to alcohol use (narrow definition) in Buckinghamshire has doubled between 2008/09 and 2017/18.

Alcohol can change behaviour and has been found to play a significant role in suicide and self-harm. In Scotland, it was found that more than half of the people who came to hospital with self-harm had drunk alcohol almost immediately before or while they harmed themselves.

Studies show that 10% to 70% of people who have attempted or completed suicide tested positive for alcohol use, depending on the study reporting the findings.

Excessive alcohol consumption over a lengthy time period can lead to brain damage and may increase the risk of developing dementia. People who binge drink are more likely to develop dementia or Alzheimer’s disease.

People with the most complex needs, such as those with both alcohol and severe mental health problems, can find it particularly hard to engage with services. They need services that are able to address their mental health and alcohol problems as part of a coordinated plan.

Research has found that drinkers with complex needs are likely to become very frequent attenders at Accident and Emergency units, often because they have nowhere else to go in moments of crisis. Engaging such people in a treatment programme can dramatically improve their lives and bring an estimated return on investment of £3,400 in savings for every £1,000 spent.

Although most women do not drink alcohol in pregnancy, those that do can cause significant harm to their babies, with higher levels of drinking causing greater problems.

There is no proven safe amount of alcohol to drink during pregnancy. If a woman drinks alcohol during pregnancy then some of the alcohol will pass through the placenta to the baby, which can lead to miscarriage or long-term harm to the baby.

Drinking more than 1.5 units of alcohol per day during the first three months of pregnancy is associated with an increased risk of miscarriage. Drinking more than one to two units per day during pregnancy increases the risk of babies being born at a low birth weight or prematurely.

Drinking four to five units per occasion while pregnant resulted in an increased likelihood of child behaviour problems.

Drinking alcohol during pregnancy also increases the risk of birth defects in the baby and can lead to a range of clinical syndromes called foetal alcohol spectrum disorders (FASD). Children may have difficulties with learning, concentration, decision making, planning and memory. Children born with FASD may also go on to have poorer educational outcomes, mental health problems and substance abuse.

Current guidelines recommend that if you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep the risks to your baby to a minimum.

The risk of injury resulting from alcohol consumption increases with the amount of alcohol consumed. Drinking too much alcohol increases the risk of road traffic crashes, poisoning, fall injuries, fire injuries, drowning, work or machine injuries.

Hospital admissions due to unintentional injuries resulting from alcohol have increased by 24.8% in Buckinghamshire between 2008/09 and 2017/18. There are now 139.7 admissions due to alcohol-related unintentional injuries for every 100,000 people in Buckinghamshire.

In 2017/18 there were 2,753 admissions to hospital primarily related to alcohol (narrow definition) and 9,046 admissions where alcohol related illnesses were listed as a factor.

The rate of alcohol-related admissions (narrow definition) was lower than the England average but similar to the south east average. In Buckinghamshire, there were 529 admissions for alcohol-related conditions per 100,000 population, compared to 515 for the south east region and 632 per 100,000 for England.

The rate of admissions in Buckinghamshire has increased by 27% since 2008, which is faster than the England rate of increase of 4% and south east increase of 4%. Admission rates for men are 60% higher than female admission rates but both men and women have seen similar increases in admission rates.

The highest admission rates in Buckinghamshire are in people over 65, followed by those aged 40-64. Admission rates for people over the age of 65 have increased by 15.5% since 2008/09, which is similar to the England rate rise of 14%.

Alcohol-related admission rates show a clear gradient across Buckinghamshire with the highest rates observed in the more deprived areas. Admission rates are 57% higher in the most deprived fifth of the population compared to the least deprived.

For almost one in five alcohol admissions, the ethnicity of the person was not recorded in Buckinghamshire. However, where ethnicity was recorded 91% were White/White British, 4% Asian/ Asian British and 1% Black/ Black British.

The rate of hospital admissions for mental health conditions due to the use of alcohol have increased by 110% since 2008 in Buckinghamshire, but the rate per 100,000 remains lower than the England and south east averages.

In Buckinghamshire, the rate of hospital admissions for alcoholic liver disease has almost doubled over the last 10 years. It has increased from 38.2 per 100,000 to 71.6 per 100,000 between 2008/09 and 2017/18.

Alcohol-specific admissions for young people under 18 have decreased by 42.8% over the last 10 years in Buckinghamshire. Over the same time period, the England average rate fell by 54.3%. In 2017/18, the admissions rate in Buckinghamshire (22.9 per 100,000) was 30% lower than in England and 29% lower than the south east region.

Alcohol-related deaths typically occur at younger ages than smoking- related deaths and deaths from all causes. On average, the age of people dying from alcohol-related causes is 54.3 years old compared to the average age for all death causes of 77.6 years in England. In the UK, the peak liver disease mortality age for women is around 55, twenty years younger than in France, where rates have fallen steeply in recent decades.

Men consume more alcohol than women nationally, and this is also reflected by the rate of alcohol-related deaths. In Buckinghamshire, the death rate from alcohol is more than twice as high in men than women (58.1 vs 21.4 per 100,000 people). In 2017 there were 198 alcohol- related deaths in adults (136 men and 62 women) in Buckinghamshire reflecting the natural picture of higher alcohol-related deaths in men.

In Buckinghamshire, there were 2029 years of life lost due to alcohol in persons aged under 75 (2017). This compares with around 2253 years of life lost due to tobacco in Buckinghamshire for the same year.

In England in 2017, the alcohol-related death rate for men in the most deprived tenth of the population was 55% higher than for men in the least deprived tenth. For women, the alcohol-related mortality rate was 45% higher in the most deprived tenth compared to the least deprived tenth.

A Buckinghamshire paramedic shared his experience of helping people who have been drinking and require medical assistance.

The consultant liver specialist in Buckinghamshire supports a wide range of people who are suffering from liver disease.

A drug and alcohol worker discussed her experience working in a local hospital. This service provides mental health support for people who come to A&E. If someone has mental health problems and drug or alcohol issues, the service may be asked to see them.