Alcohol outlet density and alcohol related hospital admissions in England: a national small‐area level ecological study

Maheswaran, Ravi; Green, Mark A.; Strong, Mark; Brindley, Paul J; Angus, Colin; Holmes, John

doi:10.1111/add.14285

Cited by 16 publications

(12 citation statements)

References 23 publications

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“…Pollution data consisted of 1 km gridded estimates of Particulate Matter of ten microns in diameter or smaller (PM 10 ) modelled by the UK’s Department for Environment, Food and Rural Affairs in the years 2004 and 2010 and assigned to LSOAs by the population weighted average for each LSOA (where the population represented the census headcounts at unit postcode level). A proxy for smoking was obtained using the number of lung cancer hospital admissions for the period 1st April 2002 to 31st March 2014 [ 43 ]. The ratio of observed to expected counts was calculated for each LSOA, with expected counts adjusted for age and sex.…”

Section: Methodsmentioning

confidence: 99%

Domestic gardens and self-reported health: a national population study

2018

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BackgroundThere is a growing recognition of the health benefits of the natural environment. Whilst domestic gardens account for a significant proportion of greenspace in urban areas, few studies, and no population level studies, have investigated their potential health benefits. With gardens offering immediate interaction with nature on our doorsteps, we hypothesise that garden size will affect general health—with smaller domestic gardens associated with poorer health.MethodsA small area ecological design was undertaken using two separate analyses based on data from the 2001 and 2011 UK census. The urban population of England was classified into ‘quintiles’ based on deprivation (Index of Multiple Deprivation) and average garden size (Generalised Land Use Database). Self-reported general health was obtained from the UK population census. We controlled for greenspace exposure, population density, air pollution, house prices, smoking, and geographic location. Models were stratified to explore the associations.ResultsSmaller domestic gardens were associated with a higher prevalence of self-reported poor health. The adjusted prevalence ratio of poor self-reported general health for the quintile with smallest average garden size was 1.13 (95% CI 1.12–1.14) relative to the quintile with the largest gardens. Additionally, the analysis suggested that income-related inequalities in health were greater in areas with smaller gardens. The adjusted prevalence ratio for poor self-reported general health for the most income deprived quintile compared against the least deprived was 1.72 (95% CI 1.64–1.79) in the areas with the smallest gardens, compared to 1.31 (95% CI 1.21–1.42) in areas with the largest gardens.ConclusionsResidents of areas with small domestic gardens have the highest levels of poor health/health inequality related to income deprivation. Although causality needs to be confirmed, the implications for new housing are that adequate garden sizes may be an important means of reducing socioeconomic health inequalities. These findings suggest that the trend for continued urban densification and new housing with minimal gardens could have adverse impacts on health.Electronic supplementary materialThe online version of this article (10.1186/s12942-018-0148-6) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Domestic gardens and self-reported health: a national population study

2018

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“…Alcohol-related hospital admission rates between adjacent LTLAs may not be independent (although there was little evidence of such in previous nation-wide analyses [36,37], and consideration of geospatial clustering may have improved the performance of our models. As individual models were constructed for each LTLA, correlations between the predictors and outcomes were allowed to differ depending on local situations.…”

Section: Strengths and Limitationsmentioning

confidence: 96%

“…However, it is important to note that we implicitly assumed geospatial independence between LTLAs. Alcohol-related hospital admission rates between adjacent LTLAs may not be independent (although there was little evidence of such in previous nation-wide analyses [36,37], and consideration of geospatial clustering may have improved the performance of our models.…”

Section: Strengths and Limitationsmentioning

confidence: 96%

Forecasting the 2021 local burden of population alcohol‐related harms using Bayesian structural time–series

et al. 2019

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Background and aims Harmful alcohol use places a significant burden on health services. Sophisticated nowcasting and forecasting methods could support service planning, but their use in public health has been limited. We aimed to use a novel analysis framework, combined with routine public health data, to improve now‐ and forecasting of alcohol‐related harms. Design We used Bayesian structural time–series models to forecast alcohol‐related hospital admissions for 2020/21 (from 2015 to 2016). Setting England. Participants We developed separate models for each English lower‐tier local authority. Measurements Our primary outcome was alcohol‐related hospital admissions. Model covariates were population size and age‐structure. Findings Nowcasting validation indicated adequate accuracy, with 5‐year nowcasts underestimating admissions by 2.2% nationally and 3.3% locally, on average. Forecasts indicated a 3.3% increase in national admissions in 2020/21, corresponding to a 0.2% reduction in the crude rate of new admissions, due to population size changes. Locally, the largest increases were forecast in urban, industrial and coastal areas and the largest decreases in university towns and ethnically diverse areas. Conclusions In 2020/21, alcohol‐related hospital admissions are expected to increase in urban and coastal areas and decrease in areas associated with inward migration of younger people, including university towns and areas with greater ethnic diversity. Bayesian structural time–series models enable investigation of the future impacts of alcohol‐related harms in population subgroups and could improve service planning and the evaluation of natural experiments on the impact of interventions to reduce the societal impacts of alcohol.

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“…Recent (2018) literature has begun to delineate outlet types; however, research has remained focused on the impact of alcohol availability on healthcare rather than the wider system. 26 Governmental alcohol policies and position papers from the alcohol industry have focused on shifting the alcohol-economy towards a diversified offer that encourages a range of activities. 27–29 Quantitative evidence supporting these policies remains sparse.…”

Section: Introductionmentioning

confidence: 99%

Observational study of the association between diverse licensed premises types and alcohol-related violence in an inner-London borough

Boshari

Sharpe

Poots

et al. 2020

J Epidemiol Community Health

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BackgroundAn ecological correlation has been observed between licensed premises and alcohol-related violence (ARV). In the UK to date, no evidence directly connects alcohol-related harm to a single premises type. Recent policies have called for a diversified alcohol offer, yet quantitative evidence in support remains sparse. This study aims to inform policy by determining whether diversification of the alcohol economy is desirable and to inform the licensing process and submission of public health evidence.MethodsUsing 11 years of local licensing data from the London Borough of Southwark, alcohol availability over time was approximated by the number of extant alcohol licences, categorised by outlet type: drinking establishments, eateries, takeaways, off-sales and ‘other’. Harm was quantified drawing on law enforcement intelligence that recorded ARV. A linked data set was analysed using negative binomial regression, contrasting cumulative impact zones (CIZ)—a common alcohol control policy—with non-CIZ geographies.ResultsEach licensed drinking establishment was associated with a 1.6% (95% CI 0.7% to 2.6%; p=0.001) increase in ARV, respectively. ‘Other’ outlets had a protective effect and were associated with a 1.8% (95% CI 1.0% to 2.5%; p<0.001) decrease in ARV.ConclusionThis study provides direct evidence for an association between alcohol-related harm and licensed premises. The varying associations between outlet type and ARV provide local public health stakeholders with an evidence base upon which to advocate for licensing policies that diversify alcohol availability.

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Alcohol outlet density and alcohol related hospital admissions in England: a national small‐area level ecological study

Cited by 16 publications

References 23 publications

Domestic gardens and self-reported health: a national population study

Domestic gardens and self-reported health: a national population study

Forecasting the 2021 local burden of population alcohol‐related harms using Bayesian structural time–series

Observational study of the association between diverse licensed premises types and alcohol-related violence in an inner-London borough

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