Alcohol : a national concern NCEPOD: measuring the units Professor - - PowerPoint PPT Presentation

Alcohol : a national concern

NCEPOD: measuring the units

Professor Martin Lombard

Alcohol related disease

NHS response to Problems & Admissions Social behaviours & attitudes Public Policy & regulation Public Health Interventions

ALCOHOL

• 200,000

400,000 600,000 800,000 1,000,000 1,200,000 1,400,000 1,600,000 1,800,000 2,000,000

Alcohol related admissions (NI39) Trends 2002-2012 and beyond

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

Pattern of deaths in England, by age, in 2007

ALL CANCERS CIRCULATORY RESPIRATORY ACCIDENTAL DEATH SUICIDE Endocrine Mental Genitourinary Other 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% < 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 Registry

Total: 500,000 deaths

GI & Liver GI cancers Alcohol Alcohol Alcohol Alcohol

SDR, chronic liver disease and cirrhosis, 0-64 per 100000

Source: WHO/Europe, European HFA Database, January 2012 England Italy France

• 1. England– rising 5% pa 1990’s, now 1.7% pa.
• 2. International– Liver disease mortality

trend dramatic increase relative to other major countries

Liver mortality: „mind the gap‟

Chronic Liver Disease (1) Mortality - 1993 & 2009

Rapid increase across the country in the last 16 years Rates per 100,000 population

(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.

North East

• 5.7 up to

13.7 North West

• 7.3 up to

15.2 Yorks & Humber

• 4.8 up to

10.2

Mortality <75 yrs Trends 1996-2008 NW

0.5 1 1.5 2 2.5 3 3.5 4 4.5 M

• H

e a r t M

• C

A l u n g M

• L

i v e r F e m a l e H e a r t F e m a l e C A L u n g F e m a l e L i v e r Mths 1996-97 1998-00 2001-03 2004-06 2006-08

„Typical‟ GP pop 10,000 (<75yrs=9,210) Expect 88 deaths pa Age <75 dying per annum = 29 Lung Cancer: 2.8 Acute myocardial infarction: 1.6 Breast cancer: 1.8 Liver disease 2.2 Chronic liver disease 60 Established cirrhosis: 6.0 Hepatocellular cancer: 0.6 Dependent drinkers: 640 Risk cirrhosis from NASH: 250 Number with hepatitis C: 40+ Number with hepatitis B: 30+ Total „at risk‟ 16-75 years:

>10%

Abnormal liver tests if checked: 10*20%

Community Liver Disease

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

Assess Think Support Patients & Carers & EOLC Rescue events

Surveillance for Complication

Treat Monitor / Review Refer / Monitor Conserve Test LIVER

NHS Ten steps to address Liver disease

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)

y = 0.3916x + 733.57 R² = 0.2515 500 1000 1500 2000 2500 3000 3500 4000 1000 2000 3000 4000 5000 6000 Thiamine Prescriptions Combined Acamprosate and Disulfiram Prescriptions

Thiamine vs. Combined Acamprosate and Disulfiram

PCT Linear (PCT)

Alcohol related Liver Disease

• Awareness & Education

(Professional attitudes)

• Identify people at risk

–Audit-C –Trauma & violence –Obesity & DM

• Brief & extended interventions
• Addiction services
• Social services
• Resilience
• Use/Agree pathways/Test

–Disperse expertise –Fibrosis markers –Follow up & repeat interventions –Join up services

• Influence your

community & leaders

• Change attitudes &

behaviours!

ALCOHOL: whose problem is it?

OURS!