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Who is at risk and why?

Background papers: Lifestyle and wider determinants :: Alcohol :: Who is at risk and why?

Alcohol and health harms

The context of alcohol use and misuse as a public health issue is due to the complex relationships between alcohol and a range of issues. Alcohol has been identified as being a causal factor in more than 200 medical conditions[1], including:


• A range of cancers, including mouth, throat, stomach, liver and breast cancer[1][2].
• Cirrhosis of the liver[1][2].
• Heart disease[1][2].
• Mental Health issues, including depression[1][2].
• Stroke[1][2].
• Pancreatitis[1][2].
• Liver disease[1][2].

It is also an influence on a range of issues linked to the wider determinants of health, such as


• Crime and disorder[3][4].
• Relationship and family problems[3][4].
• Homelessness[3][4].
• Unemployment[3][4].
• Domestic abuse[3][4].
• Child safeguarding and child sexual exploitation[1][5].
• Adult safeguarding[1].

All major body systems are affected by alcohol consumption. The effects vary according to a number of factors including age, gender, body mass index (BMI), pattern and volume of alcohol consumption and the length of time someone has been consuming alcohol[2].

General population

In 2016, among adults aged 16 years and above, 56.9% of respondents drank alcohol in the week before being interviewed for the Opinions and Lifestyle Survey, the lowest level seen since our time series began in 2005 (64.2%). This equates to around 29 million people in the population of Great Britain[6]. In 2014, over 10 million adults were regularly drinking more than the recommended maximum of 14 units of alcohol each week. Of these, 1.9 million were drinking at high-risk levels, defined as drinking more than 35 units per week for women and more than 50 units per week for men[2].

Men

31% of men in England drink alcohol in a way that presents increasing risk or potential harm to their health and wellbeing[1]. Gender and inequality gaps show that disproportionate levels of harm are impacting on men[7]. Among men, the prevalence of drinking more than 14 units a week increases with age and is most common among men aged 65 to 74 years. Thirty-nine per cent of men this age drink at this level[2].

Women

16% of women in England drink alcohol in a way that presents increasing risk or potential harm to their health and wellbeing[1]. Among women, the proportion who drink more than 14 units a week declines between the ages of 25 and 44 years, and is highest among women aged 55 to 64 years with 21% of women this age drinking at this level[2].

Unborn Children

During pregnancy alcohol can pass across the placenta to the foetus which is unable to process the alcohol in the same way as an adult. Drinking heavily can lead to Foetal Alcohol Syndrome (FAS), which is typified by restricted growth, facial abnormalities, learning and behavioural disorders. Data that would indicate incidence and prevalence are not routinely collected although numbers are likely to be low at a population level.

Age

Among those aged 15 to 49 in England, alcohol is now the leading risk factor for ill-health, early mortality and disability and the fifth leading risk factor for ill-health across all age groups[2]. Young people aged 16 to 24 years in Great Britain are less likely to drink than any other age group; when they do drink, consumption on their heaviest drinking day tends to be higher than other ages[6].

Socio economic factors

The highest earners, those earning £40,000 and above annually, are more likely to be frequent drinkers and “binge” on their heaviest drinking day when compared with the lowest earners[6]. (Binge drinkers are defined as women who drink more than 6 units and men more than 8 units on their heaviest drinking day in the previous week.)

While those from lower socioeconomic groups report lower levels of average consumption, they experience greater or similar levels of alcohol-related harm. They are more likely to die or suffer from a disease relating to their alcohol use. In England rates of alcohol-specific and related mortality increase in line with higher levels of deprivation and alcohol-related liver disease is strongly related to the socioeconomic gradient. This gives rise to what has been termed the 'alcohol harm paradox' whereby disadvantaged populations who drink the same or lower levels of alcohol, experience greater alcohol-related harm than more affluent populations. There are a number of hypotheses which try to explain this issue, although the reasons are not fully understood. Possible factors may be:


• Different drinking patterns in different socioeconomic groups[2].
• Lower resilience and/or compounding effects with other risk factors or health conditions for those in lower socioeconomic groups[2].
• Differential access to health services between socioeconomic groups[2].

Ethnicity

The proportion of adults who do not drink varies between ethnic groups[2].

Asian groups are most likely to abstain from alcohol, particularly Asian women. About 40% of Black people do not drink compared to between 10 and 15% of White ethnic groups.


References

[1]   Public Health England. Alcohol: applying All Our Health 2018;
[2]   Public Health England. The public health burden of alcohol and the effectiveness and cost-effectiveness of alcohol control policies: an evidence review 2016;
[3]   National Institute for Health and Clinical Excellence. Alcohol-use disorders - preventing the development of harzardous and harmful drinking 2010;
[4]   NICE. Alcohol-use disorders: prevention 2010;
[5]   Public Health England. Young people's drug, alcohol and tobacco use: joint strategic needs assessment (JSNA) support pack 2016-17;
[6]   Office for National Statistics. Adult drinking habits in Great Britain: 2005 to 2016 2017;
[7]   Public Health England. Local Alcohol Profiles for England 2017;