Understanding The Alcohol Harm Paradox to focus the development of interventions Professor Mark A. Bellis, Lisa Jones, Michela Morleo Centre for Public Health Liverpool John Moores University [email protected]A World Health Organiza2on Collabora2ng Centre
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Understanding
The Alcohol Harm Paradox to focus the development of interventions
Professor Mark A. Bellis, Lisa Jones, Michela Morleo
Centre for Public Health Liverpool John Moores University
Relative risks of contributions of BMI and alcohol to liver disease mortality (adjusted for all risk factors)
Adult Obesity Prevalence by Equivalised Household Income Quintile
Lowest income quintile
Highest income quintile
National Obesity Observatory: Age 16+, BMI >=30kg/m2; Health Survey for England 2006-2008
27.4% 29.3%
25.9% 24.0%
21.6%
0%
5%
10%
15%
20%
25%
30%
35%
5 4 3 2 1 Quintile Lowest income Highest income
0 50 100 150
1
2
3
4
5
Alcohol-related incapacity benefit* by deprivation quintile
Least deprived
Most deprived
Rate per 100,000 population *Incapacity benefit and severe disability allowance. LAPE, 2012!
Slipping into Deprived Communities?
?&
• Cannot afford to be ill!– Social support missing – Family wealth!– Work support missing – Employer procedures !– Increased mortality!
• Cannot afford to get better!– Remain ill but with assets could get better!– Locked into benefit system!– Increased morbidity!
• Alcoholic liver disease patients!– Surviving one year after disease !– 54% abstinent or drinking in liver safe levels!– Response to advice about liver not alcohol therapy!
Getting ill less vs. Getting ill better !
Verrill, Smith, Sheron. 2006; Tom Hennell, Pers. comm. 2013!
Female, aged 50-60 years Male, aged 50-60 years
Typical units per week 50.4 43.6 Days per week drink 6 4 Special occasions per year 0 55 Non-typical drinking periods 5.6 5 Revised units per week 50.5 68.7 Aged started drinking 30 18 A&E last 12 months No Yes Hospital admission last 12 months No No
Patterns of Drinking and Quantities Consumed!
Male, aged 20-30 years Male, aged 20-30 years
Typical units per week 47.6 43.6 Days per week drink 2 4 Non-typical drinking occasions 2 17 Non-typical drinking weeks 27 5 Revised units per week 48.4 70.3 Aged started drinking 18 15 A&E last 12 months No No Hospital admission last 12 months No No
Patterns of Drinking and Quantities Consumed!
Alcohol Research UK Flagship Grant!
• Systematic review and meta-analysis - end of October 2013!
• Analysis of national and booster surveys - end of April 2014!
• Analysis of secondary datasets - end of March 2014!
• Final synthesis and report – end of August 2014!