Alcohol-related liver disease mortality and missed opportunities in secondary care: A United Kingdom retrospective observational study

Mohsan Subhani*, Rebecca Elleray, Jane Bethea, Joanne R. Morling, Stephen D. Ryder

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    2 Citations (Scopus)


    Introduction: Alcohol-related liver disease (ARLD) is a preventable cause of mortality. Historical epidemiological studies on ARLD often lack a detailed linked assessment of health-related contacts prior to death which limits understanding of opportunities for intervention. We aimed to analyse retrospective population-based data of all adult residents of Nottinghamshire dying from ARLD to determine the factors associated with delayed diagnosis of ARLD and the potential missed opportunities for interventions. Methods: We linked the Office for National Statistics and Hospital Episode Statistics databases to identify adult (≥18 years) residents of Nottinghamshire, who died of ARLD over the 5-year period (1 January 2012 to 31 December 2017). Death was used as the primary outcome, and logistic regression analysis was conducted to test the association between key variables and mortality due to ARLD. Results: Over 5 years, 799 ARLD deaths were identified. More than half had no diagnosis or a diagnosis of ARLD less than 6 months before death. Emergency presentation at first ARLD diagnosis and White ethnicity were significantly associated with a delay in diagnosis. Overall, the cohort had a median of five hospital admissions, four accident and emergency attendances and 16 outpatient appointments in the 5 years before death. Treatment was provided by a range of specialities, with general medicine the most common. Alcohol was associated with most admissions. Discussion and Conclusions: This study identified deficiencies in ARLD secondary care and provides us with a powerful methodology that can be used to evaluate and improve how alcohol issues are managed and where action can be best targeted.

    Original languageEnglish
    Pages (from-to)1331-1340
    Number of pages10
    JournalDrug and Alcohol Review
    Issue number6
    Publication statusPublished - Sept 2022

    Bibliographical note

    Funding Information:
    Medical Research Council, Grant/Award Number: grant number MR/P008348/1 Funding information

    Funding Information:
    JRM (co-author) receives salary support from a Medical Research Council Clinician Scientist Fellowship (grant number MR/P008348/1). Rebecca Elleray undertook this work as the dissertation component of her Master's in Public Health at the University of Nottingham. The abstract of the project was accepted by the British Society of Gastroenterology as an oral presentation at the February 2020 BSG annual conference [40].

    Publisher Copyright:
    © 2022 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.


    • alcohol-related liver disease
    • mortality
    • retrospective


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