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An evidence-based alcohol policy
  1. Nick Sheron1,
  2. Noel Olsen2,
  3. Ian Gilmore3
  1. 1
    Southampton General Hospital, Southampton, UK
  2. 2
    Independent Public Health Consultant, UK
  3. 3
    Royal College of Physicians, London, UK
  1. Dr N Sheron, Division of Infection Inflammation and Repair, University of Southampton Medical School, Tremona Road, Southampton SO16 6YD, UK; nick.sheron{at}soton.ac.uk

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In October 2007 the BBC performed a survey of British Society of Gastroenterology (BSG) members in which a number of questions were asked about the changing patterns of alcohol-related disease the BSG was seeing in the UK. Of the 115 responses, only nine members had seen no change in alcohol-related liver disease over the last 10 years; 92% reported a rise, usually large. Recurrent themes were the increase in women presenting with alcoholic liver disease and the younger age of presentation. Nearly three-quarters of responders had seen patients of 25 years or under with alcoholic hepatitis or cirrhosis, and nearly a quarter had patients in their late teens. These depressing findings are in line with the report by the Chief Medical Officer in 2001:

In the last 30 years of the 20th century deaths from liver cirrhosis steadily increased, in people aged 35 to 44 years the death rate went up 8-fold in men and almost 7-fold in women, in 25–34 year-olds a 4-fold increase was seen over the 30 year period.

The UK situation is in stark contrast to the decrease in liver mortality in Mediterranean countries over the same period of time (fig 1).

Figure 1 Over the last 30 years standardised cirrhosis mortality rates (cirrhosis deaths/100 000 under the age of 64 years) have increased in the UK, Finland, Denmark and Ireland, countries where traditionally tight controls on alcohol have been relaxed, and decreased in the wine drinking countries of France, Italy and Spain where the traditionally high consumption of cheap wine with meals has reduced. The biggest drop is in France where strict controls (la loi Evin) on the promotion of alcohol were also introduced. (Data obtained from the WHO HFA database.31)

So why is the UK facing this increase in liver deaths when mortality elsewhere is falling? According to death certification data more than 80% of UK liver deaths are due to alcohol-related cirrhosis.1 Other causes of liver disease are also increasing; for example, steatosis and viral hepatitis, but only 205 out of 6889 reported liver deaths in 2005 were due to viral hepatitis.2 While viruses and, more importantly, steatosis secondary to obesity3 may be co-factors in some cases, the evidence suggests that it is our drinking habits that are the problem.

Since 1970 the standardised death rate (SDR) for cirrhosis …

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