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The Office for National Statistics (ONS) have released data on quarterly alcohol-specific deaths in England and Wales: 2001 to 2019 registrations and Quarter 1 (Jan to Mar) to Quarter 3 (July to Sept) 2020 provisional registrations.
Comment from the University of Bristol Tobacco and Alcohol Research Group:
“During the pandemic, and especially during lockdowns, there is evidence that while alcohol use for many people has decreased, it has increased for some, particularly among those with alcohol use disorders. This is likely to have worsened chronic conditions and contributed to the alcohol-related burden of disease. With alcohol consumption shifting to the home during these periods, it will be important to look at new ways of encouraging reductions in alcohol consumption, and preventing relapse among those who are abstinent from alcohol. This could include increasing the availability and prominence of alcohol-free beers, wines and spirits in supermarkets, both physical stores and online. Even a partial shift towards consumption of these products would serve to reduce the harms of excessive alcohol consumption. The fact that we see higher levels of alcohol-specific deaths in more deprived regions of the UK suggests these areas deserve particular attention.”
Prof John Holmes, Professor of Alcohol Policy and Colin Angus, Senior Research Fellow at the Sheffield Alcohol Research Group, University of Sheffield, said:
“The sharp and sustained increase in alcohol-specific deaths in Q2 and Q3 of 2020 is concerning. The ONS data are a reliable indicator of trends in deaths directly caused by alcohol, and they also provide insights into levels of alcohol consumption in England and Wales. We should therefore take trends in these data seriously.
“It is plausible that some of this increase in deaths is due to people with advanced alcohol-related health problems increasing their drinking during the pandemic. There is increasing evidence that such consumption changes have happened and there is good evidence from previous studies that short-term changes in drinking can have short-term impacts on mortality among among people who drink heavily. We also know that deaths due to alcohol are particularly likely to be subject to delays in reporting. This suggests the increase in deaths is unlikely to be due to problems with reporting of deaths during the pandemic.
“However, we should still be cautious not to over-interpret the ONS data as there may be other factors in play. In particular, people may not have accessed or received the treatment as usual during some stages of the pandemic. This may be because resources were redirected to other parts of the NHS, people had difficulties in accessing either NHS or non-NHS services, or changes in people’s willingness to try to access support. This means the increase in deaths may partly be due to whether people received treatment rather than whether people increased their alcohol consumption.
“Irrespective of the underlying cause, a sharp increase in alcohol-specific deaths is of significant concern and requires further attention.”
Prof Peter Anderson, Professor of Substance Use, Policy and Practice and Population Health, Newcastle University, said:
“This is good quality data. From previous research*, which was based on household purchases (that pretty well captured all purchases of alcohol during lock-down as pubs etc. were closed) we can see that, when accounting for foregone purchases due to closed pubs etc., households did not buy more alcohol during lockdown when compared with the same time periods during 2015 to 2018. So, on average, people were not buying more alcohol. It may well be, though, that drinking patterns changed and heavier drinkers ended up buying and drinking more alcohol, whereas lighter drinkers did the opposite – this would explain the excess deaths.
“Many chronic deaths are very sensitive to immediate changes in consumption, up and down, so if heavy drinkers drank more, this could lead to rapid deterioration in health and therefore lead to more deaths.”
* https://academic.oup.com/alcalc/advance-article/doi/10.1093/alcalc/agaa128/5988868
Prof Jonathan Shepherd, a specialist on alcohol-related harm with Cardiff University’s Violence Research Group (VRG), said:
“Whilst an increase of this magnitude in alcohol-related deaths is surprising, we have long warned about easy access to cheap drink. Alcohol related hospital admissions in the UK had already reached a record high of one and a quarter million in 2018/19 – a year before the pandemic. At present we’re getting a bad deal. The annual overall cost of alcohol harms is at least £27 billion but revenue from alcohol duty is less than half this.
“This bad deal is getting worse by the year. And not just from national and personal financial perspectives. Real term cuts in alcohol duty since 2012 are an important factor behind alcohol-related deaths. Research shows that alcohol price and affordability are powerful influences on mortality: the Violence Research Group has recommended annual, above inflation increases in duty, and minimum unit prices across the UK to ensure that stronger drinks always cost more.”
Dr Sadie Boniface, Head of Research, Institute of Alcohol Studies and Visiting Researcher, King’s College London, said:
“ONS has today released alcohol-specific deaths data for 2019, and provisional alcohol-specific deaths data for Jan to Sept 2020. These are official figures that are published routinely by the Office for National Statistics.
“The long-term trend data released today show that 2019 was the second worst year for alcohol-specific deaths since records began in 2001. The 16.7% increase in the first three quarters of 2020 compared to 2019 is therefore incredibly worrying.
“Because of the way alcohol-specific deaths are defined, most of these deaths were as a result of chronic health conditions caused by longer term higher risk or dependent drinking. Around 4 in every 5 alcohol-specific deaths is from alcoholic liver disease.
“This means the increase is not explained by people who previously drank at lower risk levels increasing their consumption during the pandemic. There have been substantial changes to drinking patterns during the pandemic, but the health consequences of these for individuals and at a population level largely remain to be seen.
“Reasons behind the increase in the first 9 months of 2020 are likely to include further increases in consumption among people who were already drinking at higher risk or dependent levels for some time, but also around access to health care. For example, liver disease often presents as an emergency, but people may have been frightened to go to A&E because of the virus. Last year there was a reduction in emergency presentations and admissions across the board, and addiction treatment data also showed fewer new clients starting treatment last summer. These deaths were not inevitable, but sadly one of many indirect consequences of the pandemic, which need to be considered carefully in recovery planning.
“There has been no progress made in reducing alcohol-specific death rates in any of the four UK constituent countries, with the exception of Scotland [figure 4 of the 2019 report]. Scotland has implemented alcohol control policies, including a lower drink drive limit in 2014 and minimum unit pricing in 2018. Now more than ever, effective policies are urgently needed across the whole of the UK to increase prices, reduce availability, and control marketing, such as those called for by the Alcohol Health Alliance.”
Professor Julia Sinclair, Chair of the Addictions Faculty at the Royal College of Psychiatrists, said:
“The all-time high rate of alcohol-specific deaths in England and Wales is as tragic as it is avoidable. Health services are ill equipped to treat the growing numbers of people who are now drinking at dangerous levels as a result of the pandemic.
“Addictions services have had seven years of funding cuts and are unable to provide the necessary support for people who are alcohol dependent. Even more lives will be lost if we don’t see urgent substantial investment from Government to enable health services to offer patients the care they need. Thousands of deaths could be prevented if services are finally given the resources to offer the right treatment when needed.”
Prof Linda Bauld, Professor of Public Health at the University of Edinburgh and Director of the SPECTRUM Consortium (www.spectrum.ac.uk), said:
“These figures for alcohol related deaths are deeply worrying but sadly not unexpected. Surveys from earlier in the pandemic suggested that while some people had reduced their alcohol consumption or abstained during the stay at home measures introduced in the spring of 2020, others were drinking more. Those who increased their consumption were already more regular drinkers. Heavier drinking over several weeks or months on top of existing alcohol harms will have contributed to this rise in deaths. In addition, vital services were paused in 2020 meaning that people who needed help with their drinking or treatment for an alcohol-related condition may not have received it, with fatal consequences for some. These are preventable excess deaths, and are a stark reminder that there are indirect harms from this pandemic beyond the immediate threat to health and life from Covid-19. As we look ahead, it is going to be essential to remember that public health is not just about dealing with infectious diseases. As part of the country’s path out of the current crisis, we must retain a focus on population and individual level policies and interventions to address alcohol harms. This must be not just for alcohol-specific deaths, but also the other conditions alcohol causes (such as cancers) and wider alcohol harms to families and society. ”
All our previous output on this subject can be seen at this weblink:
www.sciencemediacentre.org/tag/covid-19
Declared interests
Dr Sadie Boniface: I work at the Institute of Alcohol Studies which receives funding from the Alliance House Foundation.
Prof Linda Bauld: Linda Bauld is a Trustee of the Institute for Alcohol Studies and a member of Public Health England’s Alcohol Advisory Group
None others received.