Change in alcohol outlet density and alcohol-related harm to population health

223 Pages·2017·19.42 MB·English

by  Fone D

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Fone, D. ORCID: https://orcid.org/0000-0002-6476-4881, Morgan, J., Fry, R.,
Rodgers, S., Orford, S. ORCID: https://orcid.org/0000-0001-8517-4752,
Farewell, D. ORCID: https://orcid.org/0000-0002-8871-1653, Dunstan, F.
ORCID: https://orcid.org/0000-0002-1043-5281, White, J. ORCID:
https://orcid.org/0000-0001-8371-8453, Sivarajasingam, V. ORCID:
https://orcid.org/0000-0003-3541-592X, Trefan, L. ORCID:
https://orcid.org/0000-0001-9750-7112, Brennan, I., Lee, S. ORCID:
https://orcid.org/0000-0001-7763-5651, Shiode, N., Weightman, A. ORCID:
https://orcid.org/0000-0001-5210-3798, Webster, C. and Lyons, R. 2016.
Change in alcohol outlet density and alcohol-related harm to population health
(CHALICE): a comprehensive record-linked database study in Wales. Public
Health Research 4 (3) , pp. 1-184. 10.3310/phr04030 file
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PUBLIC HEALTH RESEARCH
VOLUME 4 ISSUE 3 MARCH 2016
ISSN 2050-4381
Change in alcohol outlet density and alcohol-related
harm to population health (CHALICE): a comprehensive
record-linked database study in Wales
David Fone, Jennifer Morgan, Richard Fry, Sarah Rodgers, Scott Orford,
Daniel Farewell, Frank Dunstan, James White, Vas Sivarajasingam,
Laszlo Trefan, Iain Brennan, Shin Lee, Narushige Shiode,
Alison Weightman, Chris Webster and Ronan Lyons
DOI 10.3310/phr04030

Change in alcohol outlet density and
alcohol-related harm to population health
(CHALICE): a comprehensive record-linked
database study in Wales
David Fone,1* Jennifer Morgan,1 Richard Fry,2
Sarah Rodgers,2 Scott Orford,3,4 Daniel Farewell,1
Frank Dunstan,1 James White,1,5 Vas Sivarajasingam,6
Laszlo Trefan,1 Iain Brennan,6 Shin Lee,3
Narushige Shiode,3 Alison Weightman,7
Chris Webster3 and Ronan Lyons2
1Farr Institute, Division of Population Medicine, School of Medicine,
Cardiff University, Cardiff, UK
2Farr Institute, Swansea University Medical School, Swansea, UK
3School of Geography and Planning, Cardiff University, Cardiff, UK
4Wales Institute of Social and Economic Research, Data and Methods (WISERD),
Cardiff University, Cardiff, UK
5Centre for the Development and Evaluation of Complex Interventions for Public
Health Improvement, School of Medicine, Cardiff University, Cardiff, UK
6Violence and Society Research Group, School of Dentistry, Cardiff University,
Cardiff, UK
7Specialist Unit for Research Evidence, University Library Service, CardiffUniversity,
Cardiff, UK
*Corresponding author
Declared competing interests of authors: none
Published March 2016
DOI: 10.3310/phr04030
This reportshould be referenced as follows:
FoneD,MorganJ, Fry R, Rodgers S, Orford S, Farewell D,etal. Change inalcohol outlet density
and alcohol-related harmtopopulation health (CHALICE): acomprehensive record-linked database
studyin Wales. Public HealthRes 2016;4(3).

Public Health Research
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DOI:10.3310/phr04030 PUBLICHEALTHRESEARCH2016 VOL.4 NO.3
Abstract
Change in alcohol outlet density and alcohol-related harm to
population health (CHALICE): a comprehensive record-linked
database study in Wales
David Fone,1* Jennifer Morgan,1 Richard Fry,2 Sarah Rodgers,2
Scott Orford,3,4 Daniel Farewell,1 Frank Dunstan,1 James White,1,5
Vas Sivarajasingam,6 Laszlo Trefan,1 Iain Brennan,6 Shin Lee,3
Narushige Shiode,3 Alison Weightman,7 Chris Webster3
and Ronan Lyons2
1Farr Institute, Division ofPopulation Medicine, School ofMedicine, Cardiff University, Cardiff, UK
2Farr Institute, Swansea University Medical School, Swansea,UK
3School ofGeography and Planning, Cardiff University, Cardiff,UK
4Wales Institute ofSocial and Economic Research, Dataand Methods(WISERD), Cardiff University,
Cardiff, UK
5Centre forthe Development andEvaluation ofComplex Interventions for Public Health
Improvement, Schoolof Medicine, Cardiff University, Cardiff, UK
6Violence and Society ResearchGroup, School of Dentistry, Cardiff University, Cardiff, UK
7SpecialistUnitforResearchEvidence,UniversityLibraryService,CardiffUniversity,Cardiff,UK
*Corresponding author [email protected]
Background: Excess alcoholconsumption has serious adverse effects onhealth and results in
violence-related harm.
Objective: This study investigated theimpact ofchange in community alcoholavailability on alcohol
consumption and alcohol-related harms tohealth, assessing theeffect ofpopulation migration and
small-area deprivation.
Design: A naturalexperiment of changein alcohol outlet density between 2006and 2011measured at
census Lower LayerSuper Output Area level usingobservational record-linked data.
Setting: Wales, UK;population of2.5 million aged≥16 years.
Outcome measures: Alcohol consumption, alcohol-related hospital admissions, accident and emergency
(A&E) department attendances from midnight to06.00and violent crime against theperson.
Data sources:Licensing Act 2003[Great Britain. LicensingAct 2003.London: The Stationery Office; 2003.
URL: www.legislation.gov.uk/ukpga/2003/17/contents (accessed 8June 2015)] dataon alcohol outlets
held bythe 22local authorities inWales, alcohol consumption data from annual Welsh HealthSurveys
2008–12,hospital admission data 2006–11from thePatient Episode Database for Wales (PEDW)and A&E
attendance data 2009–11 wereanonymously record linked totheWelsh Demographic Service age–sex
register within the Secure Anonymised Information Linkage Databank.A finaldata source was recorded
crime 2008–11 from thefour police forces in Wales.
©Queen’sPrinterandControllerofHMSO2016.ThisworkwasproducedbyFoneetal.underthetermsofacommissioningcontractissuedbytheSecretaryofStateforHealth.
Thisissuemaybefreelyreproducedforthepurposesofprivateresearchandstudyandextracts(orindeed,thefullreport)maybeincludedinprofessionaljournalsprovidedthat v
suitableacknowledgementismadeandthereproductionisnotassociatedwithanyformofadvertising.Applicationsforcommercialreproductionshouldbeaddressedto:NIHR
JournalsLibrary,NationalInstituteforHealthResearch,Evaluation,TrialsandStudiesCoordinatingCentre,AlphaHouse,UniversityofSouthamptonSciencePark,Southampton
SO167NS,UK.
ABSTRACT
Methods: Outletdensity was estimated (1) asthe numberofoutlets percapita for the2006 static
population and theper quarterlyupdated population toassessthe impact ofpopulation migration and
(2) using newmethods ofnetwork analysis ofdistances between each household and alcoholoutlets
within 10 minutesof walking and driving. Alcohol availability was measured by threevariables:
(1) the previous quarterlyvalue; (2) positive and negative change overthe precedingfive quarters; and
(3) volatility, ameasure ofabsolute quarterly changes during thepreceding fivequarters. Longitudinal
statistical analysis used multilevel Poissonmodels ofconsumption and Geographically Weighted Regression
(GWR) spatial models ofbinge drinking, Cox regression models ofhospital admissions and A&Eattendance
and GWR modelsofviolent crime againstthe person, eachas afunction ofalcohol availability adjusting
for confounding variables. The impact on healthinequalities was investigated by stratifying modelswithin
quintiles ofthe WelshIndex ofMultiple Deprivation.
Results: Themainfinding was that changein walking outlet densitywas associated with alcohol-related
harms: consumption,hospital admissions and violent crime against theperson eachtracked the quarterly
changes in outlet density. Alcohol-related A&Eattendances werenot clinically codedand the association
was less conclusive. In general,social deprivation was strongly associated with theoutcome measures but
did notsubstantially modify theassociations between the outcomesand alcohol availability. Wefoundno
evidence for animportant effect of populationmigration.
Limitations: Limitations included the absenceofany standardised methods ofalcohol outlet data
collation, processing and validation, and incomplete data on on-salesand off-sales. Wewere dependent
on thequality ofclinical coding and administrative records and could not identify alcohol-related
attendances in the A&Edataset.
Conclusion: Thiscomplexinterdisciplinarystudyfoundthatimportantalcohol-relatedharmswereassociated
withchangeinalcoholoutletdensity.Futureworkrecommendationsincludedefiningaresearchstandardfor
recordingoutletdataandclassificationofoutlettype,themethodologicaldevelopmentofresidence-based
densitymeasuresandahealtheconomicanalysisofmodel-predictedharms.
Funding: TheNational Institute for Health Research Public Health Researchprogramme. Additional
technical and computingsupport was provided by theFarr Institute atSwansea University, made possible
by thefollowing grant:
Centre for theImprovement ofPopulation Health through E-records Research(CIPHER) and Farr Institute
capital enhancement. CIPHERand theFarr Instituteare fundedby Arthritis ResearchUK, theBritish Heart
Foundation, Cancer ResearchUK, theChief Scientist Office (Scottish Government Health Directorates),
the Economic and Social ResearchCouncil, the Engineeringand Physical Sciences ResearchCouncil, the
Medical Research Council, theNational Institute for Health Research, theNational Institute for Social Care
and Health Research(Welsh Government) and theWellcome Trust(grant reference MR/K006525/1).
vi
NIHRJournalsLibrary www.journalslibrary.nihr.ac.uk
DOI:10.3310/phr04030 PUBLICHEALTHRESEARCH2016 VOL.4 NO.3
Contents
List oftables xi
List offigures xix
List ofboxes xxiii
List ofabbreviations xxv
PlainEnglish summary xxvii
Scientificsummary xxix
Chapter1Alcohol outlet density andharm to population health: literature review 1
Introduction 1
Methods 1
Results 2
Summary of cross-sectional studies 2
Longitudinal studies ofoutlet density and alcohol-related harm 2
Outlet density, neighbourhood deprivation and populationmigration 4
Measurement ofoutlet density 4
Summary 4
Chapter2Researchquestions 5
NationalInstitute for Health Research call 5
Primary research question 5
Secondaryresearch questions 5
Researchdesign 6
Chapter3Study setting 7
Introduction 7
LowerLayer Super OutputAreas 8
Welsh IndexofMultiple Deprivation 2008 8
Rural–urbansettlement typeclassification 9
Chapter4TheSecure Anonymised Information Linkage Databank 11
Introduction 11
WelshDemographic Service andAnonymised LinkingFields 12
WelshDemographic Service studycohorts 13
Residential Anonymous LinkingFields 13
Patient Episode Database for Wales 13
Accident and emergencydepartment attendances 14
Environment Geographic Information System 14
Researchethics and information governance 14
©Queen’sPrinterandControllerofHMSO2016.ThisworkwasproducedbyFoneetal.underthetermsofacommissioningcontractissuedbytheSecretaryofStateforHealth.
Thisissuemaybefreelyreproducedforthepurposesofprivateresearchandstudyandextracts(orindeed,thefullreport)maybeincludedinprofessionaljournalsprovidedthat vii
suitableacknowledgementismadeandthereproductionisnotassociatedwithanyformofadvertising.Applicationsforcommercialreproductionshouldbeaddressedto:NIHR
JournalsLibrary,NationalInstituteforHealthResearch,Evaluation,TrialsandStudiesCoordinatingCentre,AlphaHouse,UniversityofSouthamptonSciencePark,Southampton
SO167NS,UK.