The Portman Group welcomes the UK Government’s announcement that it has implemented an update to its use of alcohol-attributable fractions (AAFs). If you haven’t heard of them before, an AAF denotes the proportion of disease cases which are estimated to have been caused by alcohol. The change in the calculation impacts how alcohol-related mortality and hospital admissions in England are calculated. This change has been made as the result of persistent falls in the levels of drinking across the population as the latest evidence suggest that the majority of AAFs are smaller than previously thought.

Down by ¼

This led PHE to conclude that “currently published rates are too high and if LAPE [Local Alcohol Profiles for England] were to continue producing statistics using the older AAFs then this inaccuracy would continue and indeed worsen over time.”

PHE said updating its methodology to account for declining alcohol consumption across the population, as well as harmful drinking patterns such as binge drinking, would result in current estimates of alcohol-related deaths and admissions being lowered by around a quarter.

The Portman Group feels that it is important that PHE makes clear that it is changing its methodology to account for positive behaviour change amongst the general population, whilst also recognising the harm that alcohol misuse can cause to individuals remains unchanged.

Implementing the new methodology in the latest Local Alcohol Profiles for England has meant that:

• Estimated alcohol-related deaths across England for 2018 have been lowered by around 5,700. This equates to around 23% of deaths previously estimated and lowered the death rate per 100,000 for 2018 from 46.5 to 35.8.
• Estimated hospital admissions for alcohol-related conditions (narrow) for 2018 have been lowered by around 83,000. This equates to around 23% of admissions previously estimated and lowered the rate per 100,000 for 2018 from 664 to 512.
• Estimated hospital admissions for alcohol-related conditions (broad) for 2018 have been lowered by around 320,000. This equates to around 25% of admissions previously estimated and lowered the rate per 100,000 for 2018 from 2,367 to 1,766.
• However, whilst the rates have been lowered, it is important to note that the direction of the trend in rates since 2016 for mortality and admissions remains unchanged, showing the relative stasis in mortality and increase in admissions evident before the revision, which continue in the latest statistics released for 2019.

As an evidence-based body, the Portman Group support the change which is based on new data. It will present a more accurate picture and will take into account over a decade of progress of tackling many areas of alcohol-related harm, though recognise the consecutive increase in alcohol-related admissions in recent years shows there is much more to do.

The Portman Group also welcome that the update to methodology will be backdated to 2016, to allow for a more accurate long-term view of trends.

The Portman Group believe this update is especially important as it will allow policymakers to make better informed decisions and help to more effectively target policies towards those drinking at the heaviest and most harmful rates.

Taking this forward

The Government will apply this updated methodology to wider estimates of alcohol-related harm based on these calculations (i.e., previous PHE estimates on the economic cost of alcohol misuse).

Public Health England collaborates with colleagues across the UK and we hope will encourage public health authorities in Scotland, Wales and Northern Ireland to also update their own estimates of alcohol-related harm, taking account of declining trends in harm across the whole of the UK.

Overall, this consultation has been welcome chance for the Government to take ownership of over a decade of progress in tackling alcohol misuse, as the UK increasingly becomes a nation of moderate drinkers.

Read more:

• Office for Health Improvement and Disparities blog explains the new estimates on deaths and hospital admissions caused by alcohol – here.
• Previous blog write up on consultation response April 2021 – here.
• Consultation response in full April 2021 – here.

Source: Portman Group

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