Use of routinely collected Hospital Episode Statistics to describe alcohol-related frequent attenders to hospitals

Background

Excess alcohol consumption is a growing public health problem, causing 5·3% of deaths worldwide in those aged under 60 years. In the UK, alcohol use costs the National Health Service (NHS) £3·5 billion annually, 80% of which is used for hospital-based care. Alcohol-related hospital admissions have doubled in the past 8 years in England. With no universal way of identifying hospital admissions of alcohol-related frequent attenders (ARFAs), the true burden on the NHS is unknown including use of accident and emergency services, costs of inpatient admissions, and long-term health and social care. We aimed to identify characteristics of ARFAs to investigate whether they differ from other hospital service users and to better understand the complexity of this group.

Methods

Using pseudonymised Hospital Episode Statistics data from the Secondary Uses Service, ARFAs (more than three admissions per year, including at least one wholly attributable alcohol diagnosis in any diagnostic field) were identified from all admissions to south London hospitals between April 1, 2013, and March 31, 2014. Comorbidities, age, sex, and income deprivation for ARFAs were compared with those of all other admitted patients.

Findings

1897 ARFAs were identified from a total of 366?616 people admitted (5198 [0·7%] of 740?818 admissions). ARFAs were more likely than other admitted patients to be male (72·4% [1373/1897] vs 37·9% [124?919/329?218], p<0·0001), to be income deprived (Index of Multiple Deprivation 04 score 28·04, p<0·0001), and to have comorbidities (22% [417/1897] vs 8% [28?737/364?719]). ARFAs were also more likely to be older than other attenders (mean age ARFAs 55·4 years [SD 15·1] vs alcohol-related non-frequent attenders 50·0 [16·2], p<0·0001, and non-alcohol-related non-frequent attenders 51·6 [20·3], p<0·0001) but younger than non-alcohol-related frequent attenders (55·4 [15·1] vs 56·9 [21·1], p=0·01). Relative risk of comorbidity for ARFAs versus all other patients was 9·35 for self-harm (p<0·0001), 3·29 for assault (p<0·0001), 2·04 for diabetes mellitus (p<0·0001), 1·73 for circulatory disease (p<0·0001), 1·58 for cancer attributable to alcohol (p=0·0292), and 1·45 for mental health (p<0·0001).

Interpretation

ARFAs have distinct characteristics that differentiate them from other patient groups: preliminary analysis shows that ARFAs tend to be older, male, experiencing income deprivation, and more likely to have comorbidities. An understanding of the characteristics of ARFAs and their health service use might help target preventive interventions to this group, reducing harms before high costs for the NHS are accrued.

Funding

Innovation fellowship supported by the Health Innovation Network (Academic Health Science Network for South London). This research is partly funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research.