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Number of outlets selling alcohol linked to hospital admission rates

Areas with more vendors selling alcohol have higher drink-related hospital admission rates

Ingrid Torjesen

Tuesday, 21 August 2018

Areas with a high density of alcohol outlets have higher drink-related hospital admission rates, the largest study* of its kind has found.

The study, published in the journal Addiction, examined data on more than one million hospital admissions in England wholly attributable to alcohol over 12 years and included all 32,482 census areas in England.

Researchers at the University's School of Health and Related Research (ScHARR) found that places in England with the most pubs, bars and nightclubs had a 13 per cent higher admission rate for acute conditions caused by alcohol such as drunkenness and vomiting.

These areas also had a 22 per cent higher hospital admission rate for chronic conditions caused by alcohol - such as liver disease, compared with places with the lowest density of alcohol vendors.

The research, funded by Alcohol Research UK, analysed both on-trade outlets - where alcohol can be bought and consumed on the premises such as pubs, clubs and restaurants - as well as off-trade outlets - where alcohol is purchased to drink elsewhere, like supermarkets and convenience stores.

The study, which is the largest of its kind worldwide and funded by the charity Alcohol Research UK, examined data on more than one million admissions wholly attributable to alcohol over 12 years.

Places with the highest density of restaurants licenced to sell alcohol had nine per cent higher admission rates for acute conditions and nine per cent higher admission rates for chronic conditions caused by alcohol.

Areas with the highest density of other on-trade outlets (such as hotels, casinos and sports clubs) had 12 per cent higher admission rates for acute conditions and 19 per cent higher admission rates for chronic conditions caused by alcohol, compared with areas with the lowest density of other on-trade outlets.

Places with the highest density of convenience stores had 10 per cent higher admission rates for acute conditions and seven per cent higher admission rates for chronic conditions compared with areas with the lowest density of convenience stores.

Ravi Maheswaran, professor of epidemiology and public health at the University of Sheffield, said: "The strongest link was between pubs, bars and nightclubs and admissions for alcoholic liver disease.

"We also observed an association between restaurants licenced to sell alcohol and hospital admissions, which we had not expected. This needs further investigation to establish if there is a causal link.

"While convenience stores were clearly associated with hospital admissions, the association for supermarkets was modest, as we had expected. Supermarkets account for a significant proportion of alcohol sales, however they tend to serve large catchment areas whilst our study was set up to examine the effects of outlet density in small local areas."

Outlet density was measured as the number of alcohol retail outlets within a 1km radius of the centre of every residential postcode in England. This was classified into four categories, ranging from lowest to highest and the analysis adjusted for other factors which could have influenced associations, including differences in age, socio-economic deprivation and hospital admission policies in different areas.

Professor Maheswaran added: "Although we have observed clear associations between alcohol outlet densities and hospital admissions, our study cannot confirm if these associations are causally linked.

"However, there is emerging evidence from other studies suggesting that local licencing enforcement could reduce alcohol-related harms," he said.

Dr James Nicholls, director of research and policy development at Alcohol Research UK said: "Understanding the relationship between outlet density and alcohol hospital admissions is essential to reducing harm. Local licensing authorities, in particular, need to factor this information into their decisions.”


*Maheswaran R, Green MA, Strong M et al. Alcohol outlet density and alcohol related hospital admissions in England: a national small‐area level ecological study. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction, 19 August 2018, DOI: 10.1111/add.14285

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