Annual data on age-standardised and age-specific alcohol-specific death rates in the UK, its constituent countries and regions of England.

Annual data on number of deaths, age-standardised death rates and median registration delays for local authorities in England and Wales.

Alcohol-related deaths in the United Kingdom, England and Wales, and government office regions in England. Source agency: Office for National Statistics Designation: National Statistics Language: English Alternative title: Alcohol-related deaths

Potential years of life lost (PYLL) due to alcohol-related conditions, all ages, directly age-standardised per 100,000 population (standardised to the ESP).

Rationale Alcohol consumption is a contributing factor to hospital admissions and deaths from a diverse range of conditions. Alcohol misuse is estimated to cost the NHS about £3.5 billion per year and society as a whole £21 billion annually. The Government has said that everyone has a role to play in reducing the harmful use of alcohol - this indicator is one of the key contributions by the Government (and the Department of Health and Social Care) to promote measurable, evidence-based prevention activities at a local level, and supports the national ambitions to reduce harm set out in the Government's Alcohol Strategy. This ambition is part of the monitoring arrangements for the Responsibility Deal Alcohol Network. Alcohol-related deaths can be reduced through local interventions to reduce alcohol misuse and harm.

Potential years of life lost (PYLL) is a measure of the potential number of years lost when a person dies prematurely. The basic concept of PYLL is that deaths at younger ages are weighted more heavily than those at older ages. The advantage in doing this is that deaths at younger ages may be seen as less important if cause-specific death rates were just used on their own in highlighting the burden of disease and injury, since conditions such as cancer and heart disease usually occur at older ages and have relatively high mortality rates.

To enable comparisons between areas and over time, PYLL rates are age-standardised to represent the PYLL if each area had the same population structure as the 2013 European Standard Population (ESP). PYLL rates are presented as years of life lost per 100,000 population.

Definition of numerator The number of age-specific alcohol-related deaths multiplied by the national life expectancy for each age group and summed to give the total potential years of life lost due to alcohol-related conditions.

Definition of denominator ONS Mid-Year Population Estimates aggregated into quinary age bands.

Caveats There is the potential for the underlying cause of death to be incorrectly attributed on the death certificate and the cause of death misclassified. Alcohol-attributable fractions were not available for children. Conditions where low levels of alcohol consumption are protective (have a negative alcohol-attributable fraction) are not included in the calculation of the indicator.

The national life expectancies for England have been used for all sub-national geographies to illustrate the disparities in the burden caused by alcohol between local areas and the national average.

The confidence intervals do not take into account the uncertainty involved in the calculation of the AAFs – that is, the proportion of deaths that are caused by alcohol and the alcohol consumption prevalence that are included in the AAF formula are only an estimate and so include uncertainty. The confidence intervals published here are based only on the observed number of deaths and do not account for this uncertainty in the calculation of attributable fraction - as such the intervals may be too narrow.

This data shows premature deaths (Age under 75) from Liver Disease, numbers and rates by gender, as 3-year moving-averages. Most liver disease is preventable and much is influenced by alcohol consumption and obesity prevalence, which are both amenable to public health interventions. Directly Age-Standardised Rates (DASR) are shown in the data (where numbers are sufficient) so that death rates can be directly compared between areas. The DASR calculation applies Age-specific rates to a Standard (European) population to cancel out possible effects on crude rates due to different age structures among populations, thus enabling direct comparisons of rates. A limitation on using mortalities as a proxy for prevalence of health conditions is that mortalities may give an incomplete view of health conditions in an area, as ill-health might not lead to premature death. Low numbers may result in zero values or missing data. Data source: Office for Health Improvement and Disparities (OHID), Public Health Outcomes Framework (PHOF) indicator 40601 (E06a). The data is updated annually.

This dataset contains all the data tables related to the annual data on number of alcohol-specific deaths by sex, age group and individual cause of death, UK constituent countries. Published in March 2023 by the Office for National Statistics (ONS) from 2001 - 2021

Number of Alcohol Related Deaths Registered in Northern Ireland Source agency: Northern Ireland Statistics and Research Agency Designation: National Statistics Language: English Alternative title: Alcohol Deaths

Potential working years of life lost (PWYLL) due to alcohol-related conditions, ages 16-64, directly age-standardised per 100,000 population.

Rationale Alcohol consumption is a contributing factor to hospital admissions and deaths from a diverse range of conditions. The Government has said that everyone has a role to play in reducing the harmful use of alcohol - this indicator is one of the key contributions by the Government (and the Department of Health and Social Care) to promote measurable, evidence-based prevention activities at a local level, and supports the national ambitions to reduce harm set out in the Government's Alcohol Strategy. This ambition is part of the monitoring arrangements for the Responsibility Deal Alcohol Network. Alcohol-related deaths can be reduced through local interventions to reduce alcohol misuse and harm.

Years of life lost is a measure of premature mortality. The purpose of this measure is to estimate the length of time a person would have lived had they not died prematurely. As the calculation includes the age at which death occurs, it is an attempt to quantify the burden on society from the specified cause of mortality. Alcohol-related deaths often occur at relatively young ages. One of the ways to consider the full impact of alcohol on both the individual and wider society is to look at how many working years are lost each year due to premature death as a result of alcohol.

To enable comparisons between areas and over time, PWYLL rates are age-standardised to represent the PWYLL if each area had the same population structure as the 2013 European Standard Population (ESP). PWYLL rates are presented as years of life lost per 100,000 population.

Definition of numerator The number of years between a death due to alcohol-related conditions in those aged 16 to 64 years and the age of 65 years. Deaths from alcohol-related conditions are extracted and assigned an alcohol attributable fraction based on underlying cause of death (and all cause of deaths fields for the conditions: ethanol poisoning, methanol poisoning, toxic effect of alcohol). Mortality data includes all deaths registered in the calendar year where the local authority of usual residence of the deceased is one of the English geographies and an alcohol attributable diagnosis is given as the underlying cause of death.

After application of the alcohol-attributable fractions, the number of deaths at each age between 16 and 64 is summed, multiplied by the years remaining to 65, and then aggregated into quinary age bands.

References:

PHE (2020) Alcohol-attributable fractions for England: an update https://www.gov.uk/government/publications/alcohol-attributable-fractions-for-england-an-update

Definition of denominator ONS Mid-Year Population Estimates aggregated into quinary age bands.

Caveats There is the potential for the underlying cause of death to be incorrectly attributed on the death certificate and the cause of death misclassified. Alcohol-attributable fractions were not available for children. Conditions where low levels of alcohol consumption are protective (have a negative alcohol-attributable fraction) are not included in the calculation of the indicator.

Where the observed total number of deaths is less than 10, the rates have been suppressed as there are too few deaths to calculate PWYLL directly standardised rates reliably. The cut off has been reduced from 25, following research commissioned by PHE and in preparation for publication which shows DSRs and their confidence intervals are robust whenever the count is at least 10.

The confidence intervals do not take into account the uncertainty involved in the calculation of the AAFs – that is, the proportion of deaths that are caused by alcohol and the alcohol consumption prevalence that are included in the AAF formula are only an estimate and so include uncertainty. The confidence intervals published here are based only on the observed number of deaths and do not account for this uncertainty in the calculation of attributable fraction - as such the intervals may be too narrow.

Deaths from alcohol-related conditions, all ages, directly age-standardised rate per 100,000 population (standardised to the European standard population).

Rationale Alcohol consumption is a contributing factor to hospital admissions and deaths from a diverse range of conditions. Alcohol misuse is estimated to cost the NHS about £3.5 billion per year and society as a whole £21 billion annually.

The Government has said that everyone has a role to play in reducing the harmful use of alcohol - this indicator is one of the key contributions by the Government (and the Department of Health and Social Care) to promote measurable, evidence-based prevention activities at a local level, and supports the national ambitions to reduce harm set out in the Government's Alcohol Strategy. This ambition is part of the monitoring arrangements for the Responsibility Deal Alcohol Network. Alcohol-related deaths can be reduced through local interventions to reduce alcohol misuse and harm.

The proportion of disease attributable to alcohol (alcohol attributable fraction) is calculated using a relative risk (a fraction between 0 and 1) specific to each disease, age group, and sex combined with the prevalence of alcohol consumption in the population. All mortality records are extracted that contain an attributable disease and the age and sex-specific fraction applied. The results are summed into quinary age bands for the numerator and a directly standardised rate calculated using the European Standard Population. This revised indicator uses updated alcohol attributable fractions, based on new relative risks from ‘Alcohol-attributable fractions for England: an update’ (1) published by PHE in 2020. A detailed comparison between the 2013 and 2020 alcohol attributable fractions is available in Appendix 3 of the PHE report (2). A consultation was also undertaken with stakeholders where the impact of the new methodology on the LAPE indicators was quantified and explored (3).

The calculation that underlies all alcohol-related indicators has been updated to take account of the latest academic evidence and more recent alcohol-consumption figures. The result has been that the newly published mortality and admission rates are lower than those previously published. This is due to a change in methodology, mainly because alcohol consumption across the population has reduced since 2010. Therefore, the number of deaths and hospital admissions that we attribute to alcohol has reduced because in general people are drinking less today than they were when the original calculation was made.

Figures published previously did not misrepresent the burden of alcohol based on the previous evidence – the methodology used in this update is as close as sources and data allow to the original method. Though the number of deaths and admissions attributed to alcohol each year has reduced, the direction of trend and the key inequalities due to alcohol harm remain the same. Alcohol remains a significant burden on the health of the population and the harm alcohol causes to individuals remains unchanged.

References:

PHE (2020) Alcohol-attributable fractions for England: an update PHE (2020) Alcohol-attributable fractions for England: an update: Appendix 3 PHE (2021) Proposed changes for calculating alcohol-related mortality

Definition of numerator Deaths from alcohol-related conditions based on underlying cause of death, registered in the calendar year for all ages. Each alcohol-related death is assigned an alcohol attributable fraction based on underlying cause of death (and all cause of deaths fields for the conditions: ethanol poisoning, methanol poisoning, toxic effect of alcohol). Alcohol-attributable fractions were not available for children.

Mortality data includes all deaths registered in the calendar year where the local authority of usual residence of the deceased is one of the English geographies and an alcohol attributable diagnosis is given as the underlying cause of death. Counts of deaths for years up to and including 2019 have been adjusted where needed to take account of the MUSE ICD-10 coding change introduced in 2020. Detailed guidance on the MUSE implementation is available at: MUSE implementation guidance.

Counts of deaths for years up to and including 2013 have been double adjusted by applying comparability ratios from both the IRIS coding change and the MUSE coding change where needed to take account of both the MUSE ICD-10 coding change and the IRIS ICD-10 coding change introduced in 2014. The detailed guidance on the IRIS implementation is available at: IRIS implementation guidance.

Counts of deaths for years up to and including 2010 have been triple adjusted by applying comparability ratios from the 2011 coding change, the IRIS coding change, and the MUSE coding change where needed to take account of the MUSE ICD-10 coding change, the IRIS ICD-10 coding change, and the ICD-10 coding change introduced in 2011. The detailed guidance on the 2011 implementation is available at: 2011 implementation guidance.

Definition of denominator ONS mid-year population estimates aggregated into quinary age bands.

Caveats There is the potential for the underlying cause of death to be incorrectly attributed on the death certificate and the cause of death misclassified. Alcohol-attributable fractions were not available for children. Conditions where low levels of alcohol consumption are protective (have a negative alcohol-attributable fraction) are not included in the calculation of the indicator.

The confidence intervals do not take into account the uncertainty involved in the calculation of the AAFs – that is, the proportion of deaths that are caused by alcohol and the alcohol consumption prevalence that are included in the AAF formula are only an estimate and so include uncertainty. The confidence intervals published here are based only on the observed number of deaths and do not account for this uncertainty in the calculation of attributable fraction - as such the intervals may be too narrow.

Background information and/or commentary, tables and/or charts for each of the following: Accidental deaths, Alcohol-related deaths, Clostridium Difficile deaths, Hypothermia deaths, MRSA deaths, Probable suicides, and Age-Standardised death rates (calculated using the European Standard Population) overall and from a number of specific causes Source agency: National Records of Scotland Designation: National Statistics Language: English Alternative title: Deaths - various causes

Deaths from alcohol related and attributable conditions. Time period is 2002-2007 for the three sub- Community Health Partnerships in Glasgow. A Scotland wide value is also provided for comparison. The statistics are: 5-year total number and 5-year average directly age-sex standardised rate per 100,000 population per year. ScotPHO provides a technical report Data extracted: 2014-04-24 Data supplied by Information Services Division (ISD) Licence: None

Admissions to hospital where the primary diagnosis or any of the secondary diagnoses are an alcohol-specific (wholly attributable) condition. Directly age standardised rate per 100,000 population (standardised to the European standard population).

Rationale Alcohol consumption is a contributing factor to hospital admissions and deaths from a diverse range of conditions. Alcohol misuse is estimated to cost the NHS about £3.5 billion per year and society as a whole £21 billion annually.

The Government has said that everyone has a role to play in reducing the harmful use of alcohol - this indicator is one of the key contributions by the Government (and the Department of Health) to promote measurable, evidence-based prevention activities at a local level, and supports the national ambitions to reduce harm set out in the Government's Alcohol Strategy. This ambition is part of the monitoring arrangements for the Responsibility Deal Alcohol Network. Alcohol-related admissions can be reduced through local interventions to reduce alcohol misuse and harm.

Reducing alcohol-related harm is one of Public Health England’s seven priorities for the next five years (from the “Evidence into action” report 2014).

Definition of numerator Admissions to hospital where the primary diagnosis or any of the secondary diagnoses are an alcohol-specific (wholly attributable) condition code only. More specifically, hospital admissions records are identified where:

The admission is a finished episode [epistat = 3] The admission is an ordinary admission, day case or maternity [classpat = 1, 2 or 5] It is an admission episode [epiorder = 1] The sex of the patient is valid [sex = 1 or 2] There is a valid age at start of episode [startage between 0 and 150 or between 7001 and 7007] The region of residence is one of the English regions, no fixed abode or unknown [resgor<= K or U or Y] The episode end date [epiend] falls within the financial year A wholly alcohol-attributable ICD10 code appears in any diagnosis field [diag_nn]

Definition of denominator ONS mid-year population estimates.

Caveats In 2023, NHS England announced a requirement for Trusts to report Same Day Emergency Care (SDEC) to the Emergency Care Data Set (ECDS) by July 2024. Early adopter sites began to report SDEC to ECDS from 2021/22, with other Trusts changing their reporting in 2022/23 or 2023/24. Some Trusts had previously reported this activity as part of the Admitted Patient Care data set, and moving to report to ECDS may reduce the number of admissions reported for this/these indicator/s. NHSE have advised it is not possible accurately to identify SDEC in current data flows, but the impact of the change is expected to vary by diagnosis, with indicators related to injuries and external causes potentially most affected.

When considering if SDEC recording practice has reduced the number of admissions reported for this indicator at local level, please refer to the list of sites who have reported when they began to report SDEC to ECDS.

Hospital admission data can be coded differently in different parts of the country. In some cases, details of the patient's residence are insufficient to allocate the patient to a particular area and in other cases, the patient has no fixed abode. These cases are included in the England total but not in the local authority figures. Conditions where low levels of alcohol consumption are protective (have a negative alcohol-attributable fraction) are not included in the calculation of the indicator. Does not include attendance at Accident and Emergency departments.

In order to allow comparison of groups with different age structures it is common to present “age standardised” rates. These are calculated by summing the product of age specific rates for each age band in the group by the number in that age band in the standard population. The sum is then divided by the total number in all age bands in the standard population to obtain the age standardised rate. This improves the comparability of rates for different areas, or between different time periods, by taking into account differences in the age structure of the populations being compared. Any difference between groups in age standardised rates is then not due to difference in age structure since the same standard population was used to calculate all age standardised rates. The method does however assume that minor differences in age structure within age bands are unimportant and in general this is true.

This dataset presents the rate of mortality among adults receiving treatment for alcohol misuse within local authorities. It provides a measure of health outcomes for individuals engaged in alcohol treatment services and supports public health monitoring and service improvement. The indicator is expressed as a crude mortality rate per 1,000 individuals in treatment.

Rationale

The rationale for this indicator is to monitor the mortality risk among adults in alcohol treatment. Understanding these rates helps assess the effectiveness and safety of treatment services and identify areas where additional support or intervention may be needed.

Numerator

The numerator is the number of deaths among adults receiving alcohol treatment within a given local authority.

Denominator

The denominator is the total number of adults in alcohol treatment in the same local authority.

Caveats

This indicator is presented as a crude mortality rate per 1,000 individuals, which differs from the version published on OHID’s Fingertips platform, where it is expressed as a mortality ratio. Users should be cautious when comparing figures across sources due to these methodological differences.

External references

OHID Fingertips: Deaths in Alcohol Treatment

Click here to explore more from the Birmingham and Solihull Integrated Care Partnerships Outcome Framework.

Annual number of deaths registered related to drug poisoning in England and Wales by sex, region and whether selected substances were mentioned anywhere on the death certificate, with or without other drugs or alcohol, and involvement in suicides.

These data show the mortality related to "deaths of despair" - that is, deaths related to drugs, alcohol & suicide - in the UK, along with social factors which might co-vary with these deaths, such as deprivation, economic inactivity & income. These data are taken from the Office for National Statistics and are all publicly available.

This dataset presents the age-standardised mortality rate from drug misuse across the population. It captures deaths where the underlying cause is linked to mental and behavioural disorders due to psychoactive substance use (excluding alcohol, tobacco, and volatile solvents), as well as deaths involving poisoning by controlled drugs. The data is sourced from the Office for National Statistics (ONS) and is intended to support public health monitoring and policy development aimed at reducing drug-related harm.

Rationale The indicator is designed to track and reduce the mortality rate from drug misuse. Monitoring these deaths helps inform public health strategies, resource allocation, and interventions aimed at preventing drug-related harm and supporting individuals with substance use disorders.

Numerator The numerator includes deaths where the underlying cause is coded to specific categories of mental and behavioural disorders due to psychoactive substance use (excluding alcohol, tobacco, and volatile solvents), as well as deaths involving poisoning by drugs controlled under the Misuse of Drugs Act 1971. These include accidental, intentional, undetermined, and assault-related poisonings, as well as disorders due to volatile solvents.

Denominator The denominator is the total population of the relevant age group, as recorded in the 2021 Census.

Caveats There are limitations in the classification and reporting of drug-related deaths, including potential underreporting or misclassification in death records. The indicator may not capture all deaths indirectly related to drug misuse, and changes in coding practices or legal definitions over time may affect comparability.

External references Public Health England - Fingertips: Deaths from drug misuse

Click here to explore more from the Birmingham and Solihull Integrated Care Partnerships Outcome Framework.

Data using the previous National Statistics definition of alcohol-related deaths in the UK

Age-standardised rate of mortality from oral cancer (ICD-10 codes C00-C14) in persons of all ages and sexes per 100,000 population.RationaleOver the last decade in the UK (between 2003-2005 and 2012-2014), oral cancer mortality rates have increased by 20% for males and 19% for females1Five year survival rates are 56%. Most oral cancers are triggered by tobacco and alcohol, which together account for 75% of cases2. Cigarette smoking is associated with an increased risk of the more common forms of oral cancer. The risk among cigarette smokers is estimated to be 10 times that for non-smokers. More intense use of tobacco increases the risk, while ceasing to smoke for 10 years or more reduces it to almost the same as that of non-smokers3. Oral cancer mortality rates can be used in conjunction with registration data to inform service planning as well as comparing survival rates across areas of England to assess the impact of public health prevention policies such as smoking cessation.References:(1) Cancer Research Campaign. Cancer Statistics: Oral – UK. London: CRC, 2000.(2) Blot WJ, McLaughlin JK, Winn DM et al. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res 1988; 48: 3282-7. (3) La Vecchia C, Tavani A, Franceschi S et al. Epidemiology and prevention of oral cancer. Oral Oncology 1997; 33: 302-12.Definition of numeratorAll cancer mortality for lip, oral cavity and pharynx (ICD-10 C00-C14) in the respective calendar years aggregated into quinary age bands (0-4, 5-9,…, 85-89, 90+). This does not include secondary cancers or recurrences. Data are reported according to the calendar year in which the cancer was diagnosed.Counts of deaths for years up to and including 2019 have been adjusted where needed to take account of the MUSE ICD-10 coding change introduced in 2020. Detailed guidance on the MUSE implementation is available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/causeofdeathcodinginmortalitystatisticssoftwarechanges/january2020Counts of deaths for years up to and including 2013 have been double adjusted by applying comparability ratios from both the IRIS coding change and the MUSE coding change where needed to take account of both the MUSE ICD-10 coding change and the IRIS ICD-10 coding change introduced in 2014. The detailed guidance on the IRIS implementation is available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/impactoftheimplementationofirissoftwareforicd10causeofdeathcodingonmortalitystatisticsenglandandwales/2014-08-08Counts of deaths for years up to and including 2010 have been triple adjusted by applying comparability ratios from the 2011 coding change, the IRIS coding change and the MUSE coding change where needed to take account of the MUSE ICD-10 coding change, the IRIS ICD-10 coding change and the ICD-10 coding change introduced in 2011. The detailed guidance on the 2011 implementation is available at https://webarchive.nationalarchives.gov.uk/ukgwa/20160108084125/http://www.ons.gov.uk/ons/guide-method/classifications/international-standard-classifications/icd-10-for-mortality/comparability-ratios/index.htmlDefinition of denominatorPopulation-years (aggregated populations for the three years) for people of all ages, aggregated into quinary age bands (0-4, 5-9, …, 85-89, 90+)

BackgroundThe prevalence of cardiometabolic multimorbidity (CMM), which significantly increases the risk of mortality, is increasing globally. However, the role of healthy lifestyle in the secondary prevention of CMM is unclear.MethodsIn total, 290,795 participants with CMM, which was defined as coexistence of at least two of hypertension (HTN), diabetes mellitus (DM), coronary heart disease (CHD), and stroke (ST), and those without these four diseases at baseline were derived from UK Biobank. The associations between specific CMM patterns and mortality, and that between healthy lifestyle (including physical activity, smoking, alcohol consumption, and vegetable and fruit consumption) and mortality in patients with specific CMM patterns were calculated using the flexible parametric Royston-Parmar proportion-hazard model. Hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were calculated.ResultsDuring a median 12.3-year follow up period, 15,537 (5.3%) deaths occurred. Compared with participants without cardiometabolic diseases, the HRs for all-cause mortality were 1.54 [95% confidence interval (CI): 1.30, 1.82] in participants with HTN + DM, 1.84 (95% CI: 1.59, 2.12) in those with HTN + CHD, 1.89 (95% CI: 1.46, 2.45) in those with HTN + ST, and 2.89 (95% CI: 2.28, 3.67) in those with HTN + DM + CHD. At the age of 45 years, non-current smoking was associated with an increase in life expectancy by 3.72, 6.95, 6.75, and 4.86 years for participants with HTN + DM, HTN + CHD, HTN + ST, and HTN + DM + CHD, respectively. A corresponding increase by 2.03, 1.95, 2.99, and 1.88 years, respectively, was observed in participants with regular physical activity. Non-/moderate alcohol consumption and adequate fruit/vegetable consumption were not significantly associated with life expectancy in patients with specific CMM patterns.ConclusionCardiometabolic multimorbidity was associated with an increased risk of mortality. Regular physical activity and non-current smoking can increase life expectancy in patients with specific CMM patterns.

Annual full effects of policies on alcohol-related deaths, by drinking level and socioeconomic group.