New figures, published by the Office of Health Improvement and Disparities (OHID) as part of their Local Alcohol Profiles for England, show that England set another unwanted record in 2023, with the highest number of alcohol-specific deaths on record. 8,274 people died in 2023 from causes that are wholly attributable to alcohol, an increase of 4.6% from 2022 and 42.2% since 2019. As shocking as these figures are, they are only part of the picture as this measure excludes any deaths from causes where alcohol is one of, but not the only, risk factor, including cardiovascular disease and many cancers. OHID’s most recent estimates suggest that alcohol-specific deaths make up just over a third of all deaths caused by alcohol. This means that the true picture is considerably worse than this new data suggests.
The obvious question is why we’ve seen such a sharp increase in alcohol-specific deaths since the start of the COVID-19 pandemic, although the pre-pandemic trend was rising steadily. The most obvious explanation would be a big increase in drinking, but alcohol duty figures from HMRC suggesting that alcohol sales overall were relatively constant during the pandemic and have, if anything, fallen since. However, we have to recognise that this is just a measure of the population average level of alcohol consumption. Data from surveys paint a consistent picture of polarisation of drinking in the early phase of the pandemic, with heavier drinkers drinking more, while moderate drinkers cut down or even gave up alcohol entirely. We would expect rising drinking levels among heavier drinkers to lead to an increase in alcohol-specific deaths, but our previous analysis has suggested it can only explain part of the initial rise. Other factors such as the shift in specialist alcohol treatment services to online-only during lockdowns and difficulty or reluctance to access healthcare during acute phases of the pandemic are also likely to have played a role.
Perhaps the most puzzling aspect of the rising numbers of deaths is that there is some evidence that alcohol consumption among heavier drinkers has fallen since the early phases of the pandemic, although remaining above 2019 levels. Yet deaths have continued to rise over the same period. Perhaps part of the story lies in generational differences. Data from the Alcohol Toolkit suggests that the prevalence of risky drinking never rose in 16-24 year olds, that it rose and then fell back in ages 25-54, but in the over 55s it rose and remained high, or even rose further. This aligns with a longer-term trend of rising drinking among older adults – 55-74 year olds are now the heaviest drinking age group, consuming an average of 30% more alcohol each week than 16-24 year olds. Alcohol-specific deaths are highest in people in their 60s, so alcohol consumption in this age group is likely to be a major driver for overall rates of harm and could explain some of the alarming trends we’re seeing. Another potential contributing factor is the ‘cost-of-living crisis’ that has seen prices of many goods and services rise sharply since 2021. Economic hardship can lead to people cutting down on their drinking, to save money, but it can also lead to an increase in drinking as a response to stress. Recent analysis shows that 1 in 8 adults have reported financial difficulties in the past year and that this group were substantially more likely to also report psychological distress, which can often be a trigger for increased drinking.
This worsening picture in England is in contrast to Scotland, where alcohol-specific deaths were almost unchanged between 2022 and 2023 and where the rise since 2019 has been sharp, but somewhat less so than in England (the number of deaths rose by 25.2% between 2019 and 2023). It seems very likely that Scotland’s implementation of a Minimum Unit Price (MUP) for alcohol may have contributed to this relative ‘blunting’ of the worst effects of the pandemic on drinking. At the start of the pandemic, as pubs shut down, many people shifted to buying more alcohol in shops, where prices are cheaper and the same amount of money will therefore buy a lot more alcohol. The fact that the cheapest alcohol in Scotland is less cheap, as a result of MUP, than in England, may have helped limit some of this switching behaviour, something that recent research using Tesco Clubcard data seems to bear out.
Going beyond these national differences, if we look at the regional data for England, a nasty surprise awaits. For the first time on record, the rate of alcohol-specific deaths in the North East of England has overtaken the rate in Scotland. This reflects a huge shift over the past two decades. 20 years ago, Scotland had more than twice the rate of deaths of the North East. In 2023, rates in the North East were 13% higher than Scotland.
There have long been stark health inequalities within England, with higher rates of ill health and premature mortality in the North. However, the North East of England has seen notable falls in smoking prevalence in recent years, so it’s both surprising and concerning to see alcohol harms going in the opposite direction. One possible factor may be a misalignment between the need for treatment services, particularly around alcohol-related liver disease, and the quality and accessibility of local services.
The previous government often talked about reducing health inequalities and ‘levelling up’, but recent data from ONS shows that the gap in life expectancy between the best- and worst-off areas in England has risen. There is a strong relationship between rates of alcohol-specific deaths and overall life expectancy, meaning that effective policy action to tackle alcohol-related harms is likely to help to reduce these inequalities. The new government have made prevention a clear priority, but their actions are yet to match that rhetoric. It remains to be seen whether we will see clear actions to address the rising tide of alcohol harms.
Written by Colin Angus, Senior Research Fellow at the Sheffield Addictions Research Group within the School of Medicine and Population Health at the University of Sheffield.
All IAS Blogposts are published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Institute of Alcohol Studies