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O03 Inpatient Alcohol related Liver Disease (ArLD) in England and Scotland results in a large carbon footprint equivalent to approximately 13,000 transatlantic return flights
  1. William Stableforth,
  2. Ashwin Dhanda
  1. 1Department of Gastroenterology, Royal Cornwall Hospital, Truro, UK
  2. 2Faculty of Health, University of Plymouth, Plymouth, UK


Background The Climate Crisis represents the biggest global health threat of the 21st century.1 Healthcare has a significant carbon footprint which needs to be urgently reduced.2 Importing the principles of sustainable healthcare into Hepatology (figure 1) can yield carbon savings alongside opportunities for more economical, improved care which is better for our planet.3 Baseline carbon footprint data is required for patients with liver disease to help plan the journey towards Net Zero.

Aim We aimed to estimate the carbon footprint of alcohol-related liver disease (ArLD)-specific admissions to hospitals in England and Scotland in 2020/21.

Method Data was obtained from NHS Scotland using Hospital Episode Statistics for 2020/21 relating to annual admissions due to ArLD (codes K70.0, K70.1, K70.2, K70.3, K70.4, k70.9 as primary diagnosis). For England, National Hospital Episodes Statistics from 2020/21 were analysed by collaborators from the Office of Heath Improvements and Disparities using a previously described coding algorithm.4 Total bed days in 2020/21 were calculated; patients with a same day discharge were assigned a length of stay of 0.25 days. A ‘Top Down’ Carbon footprint was calculated using Sustainable Development Unit (2015). Care Pathways guidance on appraising sustainability. The carbon footprint for a low intensity bed day is 37.9 Kg CO2equivalent (KgCO2e).

Results For 2020–2021 in Scotland there were 7092 admissions with a mean length of stay of 11.3 days accounting for 80,150 bed days for ArLD as a primary diagnosis. In England there were 39856 admissions with a mean length of stay of 8.1 days totalling 324791 bed days for ArLD. Total bed days in 2020/21 were 404,941. The estimated carbon footprint of inpatient ArLD in England and Scotland is 15,347 Metric Tons CO2e.

Conclusion ArLD hospital admissions have a large carbon footprint in England and Scotland, equivalent to approximately 13,000 return transatlantic flights in 2020/21. These are the first data documenting the environmental impact of ArLD. Tackling the rising prevalence of ArLD through improved care combined with public health strategies will not only improve patient outcomes, but will reduce the significant carbon footprint associated with hospital admissions.


  1. Wang H, Horton R. Tackling climate change: the greatest opportunity for global health. Lancet 2015;386:1798–9.



  4. Kallis C, Dixon P, Silberberg B, et al. Reducing variation in hospital mortality for alcohol-related liver disease in North West England. Aliment Pharmacol Ther 2020 Jul;52(1):182–195. doi: 10.1111/apt.15781. Epub 2020 May 22.

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