Nottingham Digestive Diseases Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK.
NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.
Drug Alcohol Rev. 2022 Sep;41(6):1331-1340. doi: 10.1111/dar.13482. Epub 2022 May 31.
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.
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.
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.
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.
酒精性肝病（ARLD）是可预防的死亡原因。关于 ARLD 的历史流行病学研究通常缺乏对死亡前与健康相关的接触的详细链接评估，这限制了对干预机会的理解。我们旨在分析诺丁汉郡所有死于 ARLD 的成年居民的回顾性基于人群的数据，以确定与 ARLD 诊断延迟相关的因素以及潜在的错失干预机会。
我们将国家统计局和医院入院统计数据库链接起来，以确定诺丁汉郡在 5 年内（2012 年 1 月 1 日至 2017 年 12 月 31 日）死于 ARLD 的成年（≥18 岁）居民。死亡被用作主要结局，我们进行了逻辑回归分析，以检验关键变量与 ARLD 死亡率之间的关联。
在 5 年期间，确定了 799 例 ARLD 死亡。超过一半的人在死亡前没有诊断或诊断为 ARLD 不到 6 个月。首次 ARLD 诊断时的紧急就诊和白人种族与诊断延迟显著相关。总体而言，该队列在死亡前的 5 年内中位数有 5 次住院、4 次急诊就诊和 16 次门诊预约。治疗由一系列专科提供，其中普通医学最常见。酒精与大多数入院有关。
本研究确定了 ARLD 二级保健的不足，并为我们提供了一种强大的方法，可用于评估和改进如何管理酒精问题以及可以在哪里将行动的目标对准。
