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. 2023 Apr 19;13(4):e071024.
doi: 10.1136/bmjopen-2022-071024.

Prevalence and incidence of alcohol dependence: cross-sectional primary care analysis in Liverpool, UK

Catharine Montgomery  1 , Christine Schoetensack  2 , Pooja Saini  2 , Lynn Owens  3 , Nadja Van Ginneken  4 , Melissa Rice  5 , Ryan Young  6 , Andrew Jones  2
Affiliations

Prevalence and incidence of alcohol dependence: cross-sectional primary care analysis in Liverpool, UK

Catharine Montgomery et al. BMJ Open. .

Abstract

Objectives: Liverpool has high prevalence of alcohol use disorders (AUDs) compared with the rest of the UK. Early identification and referral in primary care would improve treatment for people with AUD. This study aimed to identify changes in prevalence and incidence of AUD in primary care in Liverpool, to identify local need for specialist services.

Design: Cross-sectional retrospective analysis of electronic health records.

Setting: National Health Service (NHS) Liverpool Clinical Commissioning Group (CCG) primary care. In total, 62 of the 86 general practitioner (GP) practices agreed to share their anonymised Egton Medical Information Systems (EMIS) data from 1 January 2017 to 31 December 2021.

Participants: Patients aged over 18 years with a SNOMED code for alcohol dependence (AD) or hazardous drinking (N=4936). Patients were excluded if they had requested that their data was not to be shared, and practices were excluded if they opted out (N=2) or did not respond to the data sharing request (N=22).

Primary and secondary outcomes: Prevalence and incidence of AUD diagnoses in primary care over the 5-year period; demographic profile of patients (sex, age, ethnicity, occupation); GP postcode; alcohol-related medications; and psychiatric and physical comorbidities.

Results: There were significant decreases in incidence of AD and hazardous drinking diagnoses over the 5 years (p<0.001 in all cases). Prevalence showed less change over time. Diagnoses were significantly higher in more deprived areas (Indices of Multiple Deprivation decile 1 vs 2-10). Overall pharmacotherapy prescriptions were lower than national estimates.

Conclusions: There are low levels of identification of AUDs in primary care in Liverpool, and this is decreasing year on year. There was weak evidence to suggest patients in the most deprived areas are less likely to receive pharmacotherapy once diagnosed. Future research should seek to investigate practitioner and patient perspectives on barriers and facilitators to management of AUDs in primary care.

Keywords: MENTAL HEALTH; PRIMARY CARE; Substance misuse.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Data acquisition flow diagram. GP, general practitioner.
Figure 2
Figure 2
Changes in incidence and prevalence over the 5-year period.
Figure 3
Figure 3
Prevalence of alcohol dependence in differing GP surgeries as a function of surgery IMD decile. GP, general practitioner; IMD, Indices of Multiple Deprivation.
Figure 4
Figure 4
Proportion of alcohol-dependent patients receiving alcohol-related prescriptions in IMD1 surgeries versus IMD2:10 surgeries. IMD, Indices of Multiple Deprivation.
Figure 5
Figure 5
Meta-regression of patient-level IMD against (A) the proportion of dependence and (B) proportion of hazardous drinking. IMD, Indices of Multiple Deprivation.
See this image and copyright information in PMC

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