‘Liver disease admissions down’ after minimum pricing introduced

Experts are encouraged by health indicators that may suggest a positive impact of the minimum unit pricing policy on alcohol, writes Sarah Devine

Cirrhosis statistics show promise

Alcohol experts have welcomed new figures which show the number of hospital admissions for liver disease has decreased since a minimum unit pricing (MUP) of 50p per unit was introduced by the Scottish Parliament 18 months ago.

Information Services Division Scotland’s report, Alcohol Related Hospital Statistics, published last month, shows that the number of people admitted to Scottish hospitals with a cirrhosis diagnosis decreased by almost 200, with the rate down from nine per 100,000 people in 2017-18 to eight per 100,000 the following year.

The condition has been the most commonly recorded alcoholic liver disease diagnosis in Scotland in the years since 2014-15.

Since 2006, Scottish Health Action on Alcohol Problems (SHAAP), a partnership of the Medical Royal Colleges in Scotland and the Faculty of Public Health, has focused on securing the implementation of MUP, which was passed into law in Scotland in 2012. SHAAP continues its efforts to ensure that the public understand and appreciate the harms that alcohol can cause.

Dr Peter Rice, SHAAP’s chair, has welcomed the reduced number of cirrhosis diagnoses, saying: “They show a decline in admission for liver disease, which we are pleased about as liver disease is a major problem here in Scotland.

“The data needs further analysis, but it shows that there are declines in hospital admissions, particularly in the lowest income group.

“This is welcome because people living in deprivation have experienced the greatest increase in rates of alcohol harm and increased rates of alcohol-related mortality since the mid-1990s.

“SHAAP’s analysis was that the health of those on lowest incomes would benefit most from MUP, so these early figures are encouraging.”

The Alcohol Related Hospital Statistics report, which is published annually and covers data from April 2018 to March 2019 in its latest release, also showed that there were seven times more hospital stays in the most deprived areas of the country, where there was at least one alcohol-related reason for admission, compared with the most affluent locations. This is a reduction from the previous year which saw eight times as many.

And, despite a general greater public concern for women’s alcohol consumption, the report also shows that men are still heavier drinkers. They are two and a half times more likely than women to be admitted to hospital for alcohol-related conditions.

However, the hospital stay rate for both males and females has decreased – by 23 and 18 per cent, respectively – since 2007-08, which marked the peak of alcohol-related hospital admissions recorded since the early 1980s.

Authors of the report also noted a strong association between age and hospital admissions, notably among men. Rice, an addiction psychiatrist, says: “There is public concern about young people drinking in the streets and public disorder, for example. But the most worrying trend is the hidden chronic harm effects, such as liver disease, on people in the middle-aged and older-aged groups.”

It has been recorded that Millennials – roughly speaking, those born between 1981 and 1996 – are less likely than the previous generation to exceed the officially recommended 14 units of alcohol per week, with twice as many men aged 55 to 64 admitted to hospital as a result of drinking.

The Information Services Division Scotland report follows recent news that the sales of alcohol north of the Border reached a 25-year record low in 2018, the smallest number since records began.

“That research showed that, compared to England, there was a downward trend in the off-sales sector in Scotland,” Rice maintains. “Scottish off-sales purchases fell by 3 per cent, having risen by a similar figure in England.

“Off-sales had been increasing in Scotland for a generation or so, so that was very welcome.

“Overall, early signs are that MUP is having effects we’d been hoping to see when we began campaigning on the issue more than ten years ago.”

MUP came into force in May 2018 and was designed to tackle Scotland’s problematic drinking culture after the increased affordability of off-sales during the 1980s and ’90s.

While some countries, including Iceland, Norway, Sweden and Finland, have long-standing government-run alcohol controls on pricing and availability, Scotland was the first in the world to implement a unit-based pricing strategy directly related to the alcoholic strength of the drink.

Now Wales is set to follow suit with a similar 50p-per-unit policy, which is expected to come into effect in March 2020. And in Ireland, there are plans to bring in rules to prevent below-price selling of alcohol within the next two years.

The Alcohol Related Hospital Statistics research will contribute to evaluation of the Scottish legislation in 2023, which will assess whether or not it has contributed to a reduction in alcohol-related health harms. Rice adds: “MUP is going to continue to be a work in progress.

“There are other things we would like to see happen, such as improvement in treatment access and action on the marketing of alcohol, but MUP is going to remain a big focus for SHAAP.

“This isn’t a ‘do it once and go away’ exercise. To maintain effectiveness, it is essential that the level of MUP keeps up with prices and incomes, and we are pleased parliament has committed to a careful evaluation.

“Findings from NHS Health Scotland are that the introduction of minimum unit pricing has gone smoothly with good co-operation from retailers. We are encouraged by these early findings and that there is evidence of reduced off-sales and improvements in some key health indicators. ”