Journal of Public Health Advance Access published online on March 18, 2009
Journal of Public Health, doi:10.1093/pubmed/fdp014
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Alcohol-related and hepatocellular cancer deaths by country of birth in England and Wales: analysis of mortality and census data
Neeraj Bhala, MRC Health Services and Health of the Public Research Fellow1,2
Raj Bhopal, Bruce and John Usher Professor of Public Health3
Anita Brock, Research Officer4
Clare Griffiths, Principal Research Officer4
Sarah Wild, Senior Lecturer in Epidemiology and Public Health3
1 Department of Gastroenterology, University Hospital of Coventry & Warwickshire, Walsgrave, Coventry CV2 2DX, UK
2 Clinical Research Sciences Institute, Medical School, University of Warwick, Walsgrave, Coventry CV2 2DX, UK
3 Public Health Sciences Section, Centre for Population Health Sciences, The University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, UK
4 Mortality Statistics, Office for National Statistics, 1 Drummond Gate, London SW1V 2QQ, UK
Address correspondence to Dr Neeraj Bhala, E-mail: neeraj.bhala{at}ctsu.ox.ac.uk
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Abstract |
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Background The incidence of and mortality from alcohol-related conditions, liver disease and hepatocellular cancer (HCC) are increasing in the UK. We compared mortality rates by country of birth to explore potential inequalities and inform clinical and preventive care.
Design Analysis of mortality for people aged 20 years and over using the 2001 Census data and death data from 1999 and 2001–2003.
Setting England and Wales.
Main outcome measures Standardized mortality ratios (SMRs) for alcohol-related deaths and HCC.
Results Mortality from alcohol-related deaths (20 502 deaths) was particularly high for people born in Ireland (SMR for men [M]: 236, 95% confidence interval [CI]: 219–254; SMR for women [F]: 212, 95% CI: 191–235) and Scotland (SMR-M: 187, CI: 173–213; SMR-F 182, CI: 163–205) and men born in India (SMR-M: 161, CI: 144–181). Low alcohol-related mortality was found in women born in other countries and men born in Bangladesh, Middle East, West Africa, Pakistan, China and Hong Kong, and the West Indies. Similar mortality patterns were observed by country of birth for alcoholic liver disease and other liver diseases. Mortality from HCC (8266 deaths) was particularly high for people born in Bangladesh (SMR-M: 523, CI: 380–701; SMR-F: 319, CI: 146–605), China and Hong Kong (SMR-M: 492, CI: 168–667; SMR-F: 323, CI: 184–524), West Africa (SMR-M: 440, CI, 308–609; SMR-F: 319, CI: 165–557) and Pakistan (SMR-M: 216, CI: 113–287; SMR-F: 215, CI: 133–319).
Conclusions These findings show persistent differences in mortality by country of birth for both alcohol-related and HCC deaths and have important clinical and public health implications. New policy, research and practical action are required to address these differences.
Keywords: cirrhosis, epidemiology, ethnicity, liver cancer, mortality
Neeraj Bhala is now at Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Clinical Medicine, Richard Doll Building, University of Oxford Old Road Campus, Headington OX3 7LF, UK