1. Observing and exploring the implications of alcohol-related acute hospital data trends in NHS Ayrshire & Arran Dr. Regina McDevitt Dr. Alister Hooke Dr. Maggie Watts Public Health Department, NHS Ayrshire & Arran

2. Part 1 Key local trends observed in an earlier study on alcohol related brain damage which prompted a deeper study of the acute hospital data

3. General acute hospital patients discharged in Ayrshire and Arran with chronic alcohol condition (1996/97-2005/06) About 100 more patients were seen in local hospitals for each chronic alcohol condition in 2005 compared to 1997

4. General acute hospital patients discharged in Ayrshire and Arran and Scotland with a diagnosis of ARBD (1996/97-2005/06) National and local rates of ARBD hospital discharges both steadily increased over 10 years Local rates consistently above national rates (~ 60%)

5. ARBD trends by Scottish region (1996/97-2005/06) : “The West of Scotland Effect” A clear distinction in the ARBD data appears between the East and West of Scotland Regardless of this distinction, rates in ARBD hospital discharges have been steadily rising across the whole of Scotland

6. Part 2 Analysis of length of stay in hospital (bed days) by patients with an alcohol-related diagnosis

7. Description of the data  Time period: 1999 to 2008  SMR1 data: acute hospital discharges  Main unit of measurement: bed days  Alcohol diagnosis in any position (of 6)  Over 34,000 alcohol-related hospital discharges  Over 21,000 individual patients

8. Analysis at individual patient level: Mean bed days used per patient with any alcohol diagnosis per annum (1999-2008) Mean bed days per patient per annum: 1999 = 6.4 bed days 2008 = 8.1 bed days Increase of about 2 bed days per patient per annum (+26%; p<0.05) Total bed days taken up by all alcohol patients: 1999 = 11,666 bed days 2008 = 18,222 bed days

9. Percentage of alcohol patients according to length-of-stay category (1999-2008) Overall 10- year decrease in shorter stays: 1-6 bed days Overall 10- year increase in longer stays: 7-30 bed days

10. Mean bed days used according to diagnosis (per patient per annum) Alcohol-related diagnosis in highest diagnostic position The biggest contributors to annual bed days used per patient are mental and behavioural problems due to alcohol, both psychotic and unspecified, and alcohol related brain damage (>10 bed days per patient per annum) Alcoholic liver disease, harmful drinking and dependent drinking occupy the middle ground (5-10 bed days per patient per annum) Intoxication and toxic effects due to alcohol tend on average to use up the least amount of bed days per patient per annum (<2 days each).

11. The biggest 10-year increases in alcohol-related hospital discharges are due to diagnoses occupying the middle range in terms of an individual’s mean annual length of stay (i.e., 5-10 bed days per patient per annum ) Trends in total annual hospital discharges by diagnosis – “The Big Hitters” 3-year average number of acute hospital discharges according to alcohol diagnosis in the highest position

12. Alcohol patients aged under 25 are more closely linked to bed stays under 7 days Alcohol patients aged 25 or over are more closely linked to bed stays of 7 or more days Analysis of bed days by age group (1999-2008)

13. Ten times more alcohol patients fall into the most compared to the least deprived category BUT… There is no difference in mean annual bed days per patient across SIMD quintiles from 1999 to 2008 (p=0.03) Analysis of bed days by deprivation category (1999-2008) SIMD1 (most deprived), SIMD5 (least deprived)

14. Alcohol bed days in Ayrshire and Arran: Summary  Significant 10-year increase (+26%) in mean bed days per annum per patient with an alcohol diagnosis in any position  Mainly due to marked increases in patients diagnosed with harmful drinking, dependent drinking and alcoholic liver disease  Older patients with alcohol problems on average stay longer in hospital. Potential effects of an ageing population should therefore be considered  There is no evidence from local data that the gender or deprivation status of alcohol patients significantly affect their length of stay in hospital

15. Part 3 Longitudinal study of acute hospital discharge histories of alcohol patients

16. Selected 930 patients in 1999 admitted to hospital diagnosed with alcohol intoxication The key predictors of whether these patients in 1999 went on to be diagnosed with more serious alcohol conditions over time were: gender, deprivation status and age: About 1 in 4 males compared to just under 1 in 5 females (p<0.05) Only 1 in 8 patients in the least deprived group (SIMD5) compared to about 1 in 4 patients in more deprived groups (SIMD1-4) (p<0.05) Younger patients were less likely to be subsequently diagnosed with a more serious alcohol condition than older patients (p<0.001) … however, older patients were likely to have had a longer history of alcohol abuse prior to the period of study.

17. GenderAge1999200020012002200320042005200620072008 A – Male422 1 31 B – Male442 21 12 C – Female63111 313 51 D – Male6900 5646259 E – Female4400 1 1427 F – Female550 151330728 G – Female360 1 46439 H – Male541 111 57101927 I – Female470 5 110 2817 J – Female420 4 14 348 K - Male590 140313 116 Patients diagnosed with: Intoxification Harmful drinking Dependent drinking Liver disease or ARBD Opportunities to intervene? Bed days used by the patient in the given year

18. These data describe the trends in alcohol discharges, the factors contributing to the increased load on acute services, and can be used to inform future service provision. We are particularly interested in identifying the right time to intervene in individuals with alcohol admissions. There have already been some changes to alcohol-related services in acute hospitals, including Alcohol Brief Interventions, which should impact on future alcohol discharges.  Conclusion