By Elizabeth Richardson

Alcohol-related death rates in Scottish neighbourhoods with the most alcohol outlets are more than double those in neighbourhoods with the fewest, even once socioeconomic deprivation is taken into account, according to a CRESH report published today.  The research is being presented today at Alcohol Focus Scotland‘s National Licensing Conference.  This blog summarises the background to the research, the key findings, and what this means for reducing further alcohol-related harm.

Alcohol consumption in Scotland

High alcohol consumption in Scotland is a well-known public health concern.  One in every twenty deaths and one in every twenty hospital episodes is attributable to alcohol¹ – substantially more than the rest of the UK, and most of the rest of Western Europe^2,3.  Alcohol misuse is estimated to cost Scottish taxpayers £3.6 billion each year – around 6% of Scotland’s public sector expenditure – when costs of healthcare, social care, crime, lost productivity and human costs are combined⁴.  Reducing alcohol-related harms would therefore benefit everyone in Scotland.  To achieve this we require a better understanding of the influences on drinking.

 

 

 

 

 

 

 

 

 

 

 

Alcohol outlet density and alcohol consumption

One potential influence is the amount of alcohol outlets (pubs, convenience stores, etc.).  In neighbourhoods with more outlets alcohol is more available, prices can be cheaper due to competitive markets, and drinking and drunkenness become more ‘normal’.  As a result, people in these neighbourhoods may consume more alcohol than those with fewer local outlets available to them, all else being equal.  Health and other negative consequences of alcohol misuse are also likely to be higher as a result.

 

 

 

 

 

 

 

 

Our study

In collaboration with Alcohol Focus Scotland the CRESH team have been examining the role of alcohol outlet availability in alcohol-related harms within Scottish neighbourhoods.  The full report can be downloaded here.  We are the first to be able to conduct this type of analysis across Scotland because of the nation-wide comprehensive alcohol outlet dataset we recently collated: see our blog post.

We used datazones to approximate local neighbourhoods – there are 6505 datazones in Scotland, with populations between 500 and 1000.  For each datazone we (a) calculated the number of alcohol outlets within 800 m (a 10-minute walk) of the population centre, (b) counted alcohol-related deaths (by age and sex; from the General Register Office for Scotland), and (c) obtained alcohol-related hospitalisation rate ratios (from the health domain of the Scottish Index of Multiple Deprivation 2012).  We then quantified the relationships between alcohol outlet availability and alcohol-related harms (while accounting for the important influences of socioeconomic deprivation and urban/rural status).

What did we find?

Alcohol outlet availability varied considerably across Scottish neighbourhoods – from low numbers in sparsely populated rural areas (light purple in example below, showing Edinburgh Local Authority area) to very high numbers in the centres of cities (dark purple).

Alcohol-related death rates in neighbourhoods with the most alcohol outlets were more than double those with the fewest.  Across the full range of outlet availability we found that datazones at sequentially higher levels of outlet availability also had higher death rates – a ‘dose-response’ trend that suggests the relationship could be causal.  The patterns were similar for on-sales outlets (licensed for on-premise consumption, e.g., bars, clubs and restaurants), and off-sales outlets (licensed for off-premise consumption, e.g., supermarkets and convenience stores), although the differences were greatest for off-sales outlets (rates in neighbourhoods with most off-sales outlets were 2.5 times those in neighbourhoods with the least).

Alcohol-related hospitalisations were also highest in neighbourhoods with the most alcohol outlets (whether on-sales, off-sales, or total) – more than 50% higher than in neighbourhoods with fewest outlets.  Again the difference was greatest for off-sales outlets (76%).

The strongest relationships were for off-sales outlets, which suggests off-sales outlets have the greatest potential for alcohol-related harm.  This is likely due to their cheaper product, large volumes obtainable, accessibility for under-age drinkers, and the absence of control over the final recipient⁵.

The results also indicate that alcohol-related deaths may be a more sensitive response to the local alcohol environment than hospitalisations.  Long-term excessive drinking resulting in chronic problems and death may be more sensitive to the local convenience and affordability of alcohol than the short-term episodes that are more likely to result in hospitalisation.

Conclusion

There is strong evidence of an association between neighbourhood alcohol outlet availability and alcohol-related health outcomes in Scotland.  The results suggest that reducing the neighbourhood availability of alcohol outlets, particularly in areas with the highest densities of outlets, could have significant health benefits for the Scottish population.

References

1. Grant I, Springbett A, Graham L. Alcohol attributable mortality and morbidity: alcohol population attributable fractions for Scotland. Edinburgh: Information Services Division, 2009.
2. Beeston C, Reid G, Robinson M, et al. Monitoring and Evaluating Scotland’s Alcohol Strategy. Third Annual Report. Edinburgh: NHS Health Scotland, 2013.
3. Breakwell C, Baker A, Griffiths C, Jackson G, Fegan G, Marshall D. Trends and geographical variations in alcohol-related deaths in the United Kingdom, 1991–2004. Health Statistics Quarterly 2007; 33: 6-24.
4. York Health Economics Consortium. The societal cost of alcohol misuse in Scotland for 2007. Available at http://www.scotland.gov.uk/Resource/Doc/297819/0092744.pdf. Edinburgh: Scottish Government Social Research, 2010.
5. Forsyth AJ, Davidson N. Community off-sales provision and the presence of alcohol-related detritus in residential neighbourhoods. Health Place 2010; 16(2): 349-58.