The Health Impacts
Diseases linked to alcohol
The harmful use of alcohol causes a large disease, social and economic burden in societies.
Alcohol consumption is a causal factor in more than 200 disease and injury conditions. Drinking alcohol is associated with a risk of developing health problems such as mental and behavioural disorders, including alcohol dependence, major noncommunicable diseases such as liver cirrhosis, some cancers and cardiovascular diseases, as well as injuries resulting from violence and road clashes and collisions.
The latest causal relationships are those between harmful drinking and incidence of infectious diseases such as tuberculosis as well as the incidence and course of HIV/AIDS. Alcohol consumption by an expectant mother may cause fetal alcohol syndrome and pre-term birth complications. (WHO Alcohol fact sheet 2018)
For most conditions in which alcohol is a factor, there is a dose-dependent relationship. That is, the more alcohol is consumed, the greater the risk of alcohol-related health harm.
There is no guaranteed safe level of alcohol consumption.
Government guidelines in Scotland and the UK recommend no more than 14 units per week to keep the risk of health damage low.
Alcohol-specific deaths refer to deaths which are known to be direct consequences of alcohol misuse, meaning they are wholly attributable to alcohol misuse.
- There were 1,020 alcohol-specific deaths registered in Scotland in 2019 - that's almost 20 per week. This is the lowest annual total since 2013 (1,002 deaths)
- The main cause of such deaths is alcohol-related liver disease, followed by mental and behavioural diseases due to use of alcohol
- Males accounted for nearly two-thirds (65%) of alcohol-specific deaths in 2019
- Most alcohol-specific deaths are amongst people in their 50s/60s (58%)
- The figure for 2019 shows a considerable fall in the number of alcohol-specific deaths since 2018 (10%), and 2019 represents the first substantial decrease in recent years, after a period of general increase since 2012. Minimum unit pricing (MUP) for alcohol was implemented in Scotland on 1 May 2018, which may have contributed to the reduction in deaths from 2018-2019, although further years will be required to see if this reduction is sustained
Alcohol-attributable deaths (AADs) refer to deaths caused by 20 wholly (i.e. 'alcohol-specific') and 30 partially attributable conditions. Partially attributable conditions include several cancers, coronary heart disease and stroke.
In 2018, NHS Health Scotland and ScotPHO published a report on "Hospital admissions, deaths and overall burden of disease attributable to alcohol consumption in Scotland". This provides information on deaths attributable to alcohol consumption in 2015:
- There were an estimated 3,705 deaths attributable to alcohol consumption in 2015 among adults aged 16 years and over in Scotland. This equates to 6.5% of the total number of deaths (57,327)
- Men were almost twice as likely to die from an alcohol-attributable condition in 2015 compared with women (8.4% and 4.7%, respectively)
- More than one in four (28%) alcohol-attributable deaths were due to cancer
- Main causes of AADs for people under 35 are intentional self-harm, traffic accidents and poisoning
- Main causes of AADs for people over 35 are alcohol-related liver disease, mental and behavioural disorders and breast/oesophageal cancers
Alcohol-related hospital stays
Public Health Scotland produces reports on alcohol-related inpatient and day case activity within general acute and psychiatric hospitals in Scotland, relating to admissions that are entirely due to alcohol. The latest report reveals:
- There were 35,781 alcohol-related hospital admissions (stays) in general acute hospitals in Scotland in the financial year 2019-20. These admissions relate to 23,685 patients (i.e. some had multiple admissions to hospital); around half (11,901) were admitted for the first time for alcohol-related conditions
- Alcohol-related admissions peaked at 855 per 100,000 population in 2007-8 after increasing for over 25 years, but have since declined to 667 per 100,000 in 2019-20
- Men were 2.4 times more likely than women to be admitted to general acute hospitals for alcohol-related conditions (937 per 100,000 population compared to 396)
- People in the most deprived areas were seven times more likely to be admitted to general acute hospitals for an alcohol-related condition than those in the least deprived areas (1,079 per 100,000 population compared to 155)
In 2018, NHS Health Scotland and ScotPHO published a report on "Hospital admissions, deaths and overall burden of disease attributable to alcohol consumption in Scotland". This provides information on the number of patients admitted to hospital due to alcohol consumption in 2015, and includes admissions due to 20 wholly (i.e. 'alcohol-specific') and 30 partially attributable conditions:
- A total of 41,161 adults aged 16 years and over were admitted to hospital at least once with a wholly or partially alcohol-attributable condition (6.4% of 644,574 total individuals admitted at least once in 2015)
- Men were twice as likely to be hospitalised with an alcohol-attributable condition compared with women (8.8% and 4.3%, respectively)
- Of the adult patients hospitalised due to alcohol, more than one in four (27%) were admitted for an unintentional injury
Alcohol and Cancer
In October 2019, SHAAP released our updated version of Alcohol & Cancer Risks: A Guide for Health Professionals. The new guidance points out that more than a quarter of alcohol-attributable deaths are due to cancer. Drinking alcohol increases your risk of developing the following cancers of the: lip, oral cavity and pharynx; larynx; oesophagus; breast; colon and rectum; and the liver. There is also a relationship between alcohol and cancer of the stomach and there is some evidence that alcohol is associated with several other cancers, e.g. pancreatic cancer, lung cancer and melanoma. The guide points to emerging research that draws links between alcohol and tobacco use; and also presents evidence that drinking alcohol can interfere with recovery from cancer. The risks associated with cancer start from any level of regular drinking and rise with the amounts of alcohol being drunk. Information is provided for health staff to support their advice-giving on how to manage alcohol and reduce alcohol consumption. Recommendations are made for action to reduce alcohol consumption, both at the individual and population level:
- Amongst health professionals there needs to be an increased understanding of the relative risks of consuming alcohol.
- Low rates of awareness in public audiences may need information to be tailored to the specific needs of target groups.
- Understanding and communicating “risk” is as much a challenge for professionals as the general public.