Could Booze Duty Rise Cut A&E Admissions?

A small rise of 1% in alcohol prices could significantly reduce violence-related injuries in England and Wales, consequently reducing their burden on hard-pressed emergency departments, concludes a study by Cardiff University. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

Published in Injury Prevention, the study finds that violence-related emergency department (ED) attendance is greater when alcohol prices are lower and estimates that over 6,000 fewer violence-related ED attendances per year would result from a 1% rise above inflation on alcohol sold through drinking establishments and shops.
Professor Jonathan Shepherd, Director of the Violence Research Group at Cardiff University, one of the authors of the study, said: ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“While alcohol-related violence is generally on the decline in England and Wales it still remains a big problem and places a substantial burden on health services and our emergency departments. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“Our findings suggest that reforming the current alcohol taxation system would be more effective at reducing violence-related injury than minimum unit pricing and would lead to substantial reductions in violence nationally. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“However, any such policy would need to increase the price of alcohol in both markets, especially within drinking establishments. The additional tax revenue of about £1 billion a year could be used to offset the cost of alcohol-related harm to the NHS.” ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

Worldwide, interpersonal violence was the second leading cause of death among young men aged 15-29 in 2012, and more than 210,000 people sought emergency care in England and Wales for injuries sustained during an episode of violence in 2015. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

The new study assessed the impact of on-trade (pubs/clubs/bars) and off-trade (retail outlets) alcohol pricing, as well as socioeconomic and environmental factors, on the rate of violence-related attendances at EDs in England and Wales. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

Anonymised data were collected on adults who had visited 100 EDs across England and Wales between 2005 and 2012, as a result of injuries sustained during episodes of violence. Nationally available data on alcohol pricing, expenditure and prevailing socioeconomic factors for the eight year period were also studied. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

Between 2005 and 2012, just short of 300,000 visits were made by adults to 100 EDs in England and Wales as a result of injuries sustained during violence, equating to an estimated 2.1m visits in total. Three out of four attendees were men, aged between 18 and 30; monthly injury rates among men were around three times as high as they were among women. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

Regional and seasonal variations were evident too, with higher violence-related injury in the North West and North East of England and in Wales, and during the summer (June-August). ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

Analysis of the data showed that lower on trade and off-trade alcohol prices were associated with higher numbers of violence-related attendances at hospital emergency departments, after taking account of poverty, differences in household income, spending power and time of year. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

An estimated rise in on-trade alcohol prices of 1% above inflation could cut the annual tally of violence fuelled emergency care visits by 4,260, while the equivalent increase in off-trade alcohol prices could mean 1,788 fewer annual attendances, adding up to around 6,000 fewer visits in total. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

However, of all the factors studied, poverty and the disparity between the haves and have-nots were the strongest predictors of violence-related injury rates. A 1% drop in the prevalence of poverty and a 0.01 fall in the difference between those at the top of the income scale and those at the bottom could result in 18,000 fewer visits to emergency care every year. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

There are some caveats: emergency care data on violence are unlikely to capture the whole picture as some patients may be unwilling to reveal the cause of their injuries; emergency care only deals with the more serious end of the spectrum; while living close to an emergency care department may influence the likelihood of using it for treatment. All these factors tend to underestimate the benefits of small price increases. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

Furthermore, given the high proportion of 18 to 30 year old men in the sample, it is possible that the data represent street violence rather more than domestic and other types of violence. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

The study – Preventing violence-related injuries in England and Wales: a panel study examining the impact of on-trade and off-trade alcohol prices – is published in the journal Injury Prevention. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​