Home > New HRB trends paper on alcohol-related deaths.

Lyons, Suzi (2011) New HRB trends paper on alcohol-related deaths. Drugnet Ireland , Issue 39, Autumn 2011 , pp. 1-3.

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On 12 July the third publication from the National Drug-Related Deaths Index (NDRDI) was launched.1  The paper describes, for the first time, trends in alcohol-related deaths and deaths among people who were alcohol dependent in Ireland for the years 2004−2008. The NDRDI was established in September 2005 as a system for recording drug-related deaths and deaths among drug users;2  its remit was expanded in January 2006 to include alcohol-related poisonings and deaths among people who were alcohol dependent.   

The NDRDI retrospectively recorded from 2004 onwards: 

·         deaths in which alcohol was implicated (regardless of history of alcohol dependence); and

·         deaths of individuals reported in any of the data sources as having been ‘an alcoholic’ or ‘alcohol dependent’ or suffering from ‘chronic alcohol use’ or having had a diagnosis of ‘alcohol dependence syndrome’ (exact terms only) and/or one or more of the relevant International Classification of Diseases (ICD) codes (F10.2 to F10.9).

According to the World Health Organization (WHO), alcohol is the eighth leading cause of death in the world.3 Most alcohol-attributable deaths are due to injury, cancer, liver cirrhosis or cardiovascular disease.

 

Poisoning deaths

Alcohol-related poisonings

Between 2004 and 2008, 672 poisoning deaths in which alcohol was implicated (alone or in conjunction with other drugs) were recorded (Table 1).  This makes alcohol the drug most frequently implicated in all fatal poisonings in Ireland in the five-year period.  Most of those who died were male. The highest number of deaths was recorded in 2007 (170).   The median age of those who died of alcohol-only poisoning was 48 years, that of those who died of alcohol polysubstance (alcohol plus other substance/s) poisoning was 41 years.

 

 Table 1   Alcohol-related poisoning deaths (NDRDI 2004–2008) (N = 671)

 
2004
2005
2006
2007
2008
Total
125
116
111
170
150
 
 
 
 
 
 
Alcohol only (n = 331)
61
51
54
85
80
Alcohol polysubstance (n = 341)
64
65
57
85
70

Just over half (50.7%) of all alcohol-related poisonings involved another substance. Most commonly implicated along with alcohol were benzodiazepines (61.3%) and opiates (including heroin and methadone) (55.7%) (Table 2).

 

All NDRDI-recorded poisoning deaths
Table 3 presents data on alcohol poisonings alongside data on poisonings from all other substances in order to compare the contribution of alcohol to fatal poisonings nationally.  Alcohol was implicated in 40.7% of all poisonings, making it the drug most frequently implicated in fatal poisonings in Ireland for the period 2004–2008.

Non-poisoning deaths in those who were alcohol dependent
There were 3,336 non-poisoning deaths of people who were alcohol dependent, increasing from 508 in 2004 to 799 in 2008 (Table 4). Almost all (89.2%) were due to medical causes, the remainder (10.8%) were due to traumatic causes.

The NDRDI assigns medical and traumatic causes of death to a limited number of broad categories to allow for data to be presented in a meaningful way.   

Examples of medical-cause categories:
·         Haemorrhage includes deaths due to ruptured oesophageal varices, gastrointestinal bleed (but not cerebral haemorrhage);
·         Cerebral includes deaths as a result of a stroke, cerebral haemorrhage (non-traumatic);
·         Other respiratory disease includes emphysema, chronic obstructive airways disease;
·         Other infection includes sepsis or peritonitis.
 
Examples of traumatic-cause categories:
·         Fall includes deaths as a result of a fall from a height (from a building or down a stairs) or fall on same level (trip over step or from footpath)
·         Choking includes deaths as a result of asphyxia due to foreign body (for example food or vomit);
·         Violence includes fatal injuries as a result of an assault, shooting or stabbing;
·         Road traffic collision (RTC) includes drivers (of any vehicle), passengers or pedestrians.
 
Deaths from medical causes
The number of deaths from medical causes in people who were alcohol dependent rose from 459 in 2004 to 720 in 2008. Half were aged 59 years or under and the highest number of cases was in the 55–59-year age group (15.7%). Seventy-four per cent were male. The most frequent causes of death in this group were: alcoholic liver disease (23.6%); cardiac conditions (17.2%); and respiratory infections (11.4%).
 
Deaths from traumatic causes
The number of deaths as a result of a traumatic event was highest in 2006 (103 deaths). Half were aged 49 years or under. The most frequent causes of death in this group were: falls (39.9%); hanging (19.4%); and choking (12.2%).  
 
Deaths from medical or traumatic causes that also involved alcohol, of people who were not alcohol dependent
A further 215 non-poisoning deaths in which alcohol was implicated were recorded among people who did not have a recorded history of alcohol dependence. The number of these deaths increased from 14 in 2004 to 84 in 2008. The majority (66.0%) died as a result of traumatic events, most commonly drowning (21.1%) and choking (18.3%).
 
Conclusion
The increase in the number of deaths recorded may be explained by a number of factors. It could indicate a true increase in the number of deaths, or an effect of  improved recording practices, as the NDRDI is a relatively new system. However, given that the per capita consumption of alcohol in Ireland is among the highest in Europe,4 and that 56% of Irish people drink in a harmful manner,5 a combination of these factors is the most likely explanation.
 
Alcohol was the drug most frequently implicated in all fatal poisonings in Ireland in the five-year period. The findings of this analysis in relation to the types of non-poisoning deathin which alcoholwas implicated are similar to those of other international research on alcohol-attributable mortality. However, the NDRDI data will need to be further analysed in detail to better understand the relationship between alcohol use and specific diseases, for example breast or oesophageal cancer.
 
The analysis showed clearly the extent of premature mortality as many of those who died were still in their prime, aged between 40 and 59 years. The NDRDI will be able to measure the effects of any changes in public health policy on alcohol-related mortality in the Irish population.
 
1. Lyons S, Lynn E, Walsh S, Sutton M and Long J (2011) Alcohol-related deaths and deaths among people who were alcohol dependent in Ireland, 2004 to 2008. HRB Trends Series 10. Dublin: Health Research Board. www.drugsandalcohol.ie/15370
2. Lyons S, Lynn E, Walsh S and Long J (2008) Trends in drug-related deaths and deaths among drug users in Ireland, 1998 to 2005. HRB Trends Series 4. Dublin: Health Research Board. www.drugsandalcohol.ie/11513
3. World Health Organization (2011) Global status report on alcohol and health. Geneva: World Health Organization. www.who.int/substance_abuse/en
4. OECD (2010) OECD health data 2010 - frequently requested data. Accessed May 2011 at www.oecd.org/dataoecd/52/42/48304068.xls 
5. Morgan K, McGee H, Watson D, Perry I, Barry M, Shelley E et al. (2008) SLÁN 2007: survey of lifestyle, attitudes and Nutrition in Ireland. Main report. Dublin: Department of Health and Children.
Item Type:Article
Issue Title:Issue 39, Autumn 2011
Date:2011
Page Range:pp. 1-3
Publisher:Health Research Board
Volume:Issue 39, Autumn 2011
EndNote:View
Accession Number:HRB (Available)
Subjects:A Substance use, abuse, and dependence > Prevalence > Problem substance use
VA Geographic area > Europe > Ireland
P Demography, epidemiology, and history > Population dynamics > Substance related mortality / death
G Health and disease > Substance use disorder > Alcohol use

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