26. HOSPITAL STAYS DUE TO ALCOHOL INDICATOR
TABLE 1 – INDICATOR DESCRIPTION
| Information component | Pg 4 Health Summary – Indicator No. 26 |
| Subject category / domain(s) | Health and ill health in our community |
| Indicator name (* Indicator title in health profile) | Alcohol Specific Hospital Admissions (*Hospital stays due to alcohol) |
| PHO with lead responsibility | NWPHO |
| Date of PHO dataset creation | Dec. ‘06 |
| Indicator definition | Alcohol Specific Hospital Admissions, directly age standardised rate, All Ages, 2005-06, persons |
| Geography | England, GOR, Local Authority: Counties, County Districts, Metropolitan County Districts, Unitary Authorities, London Boroughs |
| Timeliness | Updated every year, next update available in 2008. Time trend analysis is appropriate from data available from the NWPHO. Time trend analysis should not be done between HP1 and HP2 because the indicator calculation changed from multiple years to a single year. |
| Rationale:What this indicator purports to measure | This indicator measures the number of persons admitted to hospital for alcohol specific conditions (e.g. alcoholic liver disease, or acute alcohol intoxication). |
| Rationale:Public Health Importance | The acute or long term effects of excessive alcohol consumption are a major cause of avoidable hospital admissions. |
| Rationale: Purpose behind the inclusion of the indicator | To help monitor likely health care burden. |
| Rationale:Policy relevance | Alcohol Harm Reduction Strategy for England (2004) |
| Interpretation: What a high / low level of indicator value means | A high indicator value (red circle in health summary chart) represents a statistically significant higher level of alcohol specific hospital admissions for that local authority when compared to the national value.A low indicator value (amber circle in health summary chart) represents a statistically significant lower level of alcohol specific hospital admissions for that local authority when compared to the national value. |
| Interpretation: Potential for error due to type of measurement method | Hospital admission data can be coded differently in different parts of the country.Identification of persons in any one year can also affect the analysis if people are prone to moving within a local authority on a regular basis. |
| Interpretation: Potential for error due to bias and confounding | |
| Confidence Intervals: Definition and purpose | A confidence interval is a range of values that is normally used to describe the uncertainty around a point estimate of a quantity, for example, a mortality rate. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. These occurrences result in random fluctuations in the indicator value between different areas and time periods. In the case of indicators based on a sample of the population, uncertainty also arises from random differences between the sample and the population itself.The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. Confidence intervals quantify the uncertainty in this estimate and, generally speaking, describe how much different the point estimate could have been if the underlying conditions stayed the same, but chance had led to a different set of data. The wider is the confidence interval the greater is the uncertainty in the estimate.Confidence intervals are given with a stated probability level. In Health Profiles 2007 this is 95%, and so we say that there is a 95% probability that the interval covers the true value. The use of 95% is arbitrary but is conventional practice in medicine and public health. The confidence intervals have also been used to make comparisons against the national value. For this purpose the national value has been treated as an exact reference value rather than as an estimate and, under these conditions, the interval can be used to test whether the value is statistically significantly different to the national. If the interval includes the national value, the difference is not statistically significant and the value is shown on the health summary chart with a white symbol. If the interval does not include the national value, the difference is statistically significant and the value is shown on the health summary chart with a red or amber symbol depending on whether it is worse or better than the national value respectively. |
TABLE 2 – INDICATOR SPECIFICATION
| Indicator definition: Variable | Alcohol Specific Hospital Admissions |
| Indicator definition: Statistic | Directly age-standardised rate |
| Indicator definition: Gender | Persons |
| Indicator definition: age group | All Ages |
| Indicator definition: period | 2005-06 |
| Indicator definition: scale | Per 100,000 European Standard population |
| Geography: geographies available for this indicator from other providers | The following geographies: England, GOR, Local Authority: County Districts, Metropolitan County Districts, Unitary Authorities, London Boroughs, for this and other alcohol related indicators are available from the NWPHO web site.www.nwph.net/alcohol/lape |
| Dimensions of inequality: subgroup analyses of this dataset available from other providers | Further breakdown of the indicator will be available in the Alcohol Indications Report due to be published July 2007. This will provide a breakdown by Deprivation Quintile and Geodemographic classification. |
| Data extraction: Source | The Information Centre for Health and Social Care – HES |
| Data extraction: source URL | HES Safe Haven download |
| Data extraction: date | Data extracted from source as at: Dec. ‘06 |
| Numerator: definition | Persons admitted to hospital where the any diagnosis field includes any one of the listed conditions which are specific to alcohol misuse (ICD10: E24.4, F10, G31.2, G62.1, G72.1, I42.6, K29.2, K70, T510, T511, X45). E244 Alcohol-induced pseudo-Cushing’s syndromeF10 Mental and behavioural disorders due to use of alcoholG312 Degeneration of nervous system due to alcoholG621 Alcoholic polyneuropathyI426 Alcoholic cardiomyopathyK292 Alcoholic gastritisK292 Alcoholic liver diseaseT510 Ethanol poisoningT511 Methanol poisoningAnnual totals for 2005/06. A person is counted once in the financial year. Persons are assigned to a 5 year age band based on age at admission. |
| Numerator: source | The information centre for Health and Social Care – HES Team. |
| Denominator: definition | Mid-year population estimates by 5-year age band for the year 2005. |
| Denominator: source | Office for National Statistics (ONS). |
| Data quality: Accuracy and completeness | HES Data and ONS population statistics are considered to be complete and robust. |
TABLE 3 – INDICATOR TECHNICAL METHODS
| Numerator: extraction | All FCEs across England residents with a specified diagnosis in ANY of the HES diagnostic fields HES extraction, ICD-10 codes: E244, F10, G312, G621, G721, I426, K292, K70, T510, T511, X45The following fields and values are used for the numerator:DIAG_01 to Diag_14 in the valid list for this indicator (any diagnosis);AND SEX = 1 or 2 (sex);AND CLASSPAT NOT 3, 4 (patient classification);AND STARTAGE is 0-120 or 7001-7007 (age at start of episode).AND RESGOR is A,B,D,E,F,G,H,J,KCounts are by: age / sex / individual (distinct hesid): age bands <1, 1-4, 5-9, … , 80-84, 85+;sex is 1, 2 (male and female)LSOA. |
| Numerator: aggregation /allocation | Aggregated from Postcode of residence to LA of residence using the Gridlink postcode file Nov 2006 |
| Numerator data caveats | Hospital admission data can be coded differently in different parts of the country.Identification of persons in any one year can also affect the analysis if people are prone to moving within a local authority on a regular basis |
| Denominator data caveats | |
| Methods used to calculate indicator value | The directly age-standardised rate is the rate of events that would occur in a standard population if that population were to experience the age-specific rates of the subject population. Explicitly: (expressed per 100,000 population)where:wi is the number, or proportion, of individuals in the standard population in age group i.ri is the crude age-specific rate in the subject population in age group i, given by: where:Oi is the observed number of events in the subject population in age group i.ni is the number of individuals in the subject population in age group i.The standard population generally used for the direct method is the European Standard Population. |
| Small Populations: How Isles of Scilly and City of London populations have been dealt with | Isles of Scilly and City of London were excluded. Though these are available from www.nwph.net/alcohol/lape. |
| Disclosure Control | Not applicable |
| Confidence Intervals calculation method | Confidence intervals for the rates were calculated using the method described in the NCHOD Compendium for directly standardised rates. www.nchod.nhs.uk 95% confidence intervals for the age-standardised rates were calculated using a normal approximation. Standard errors are obtained using the method described by Breslow and Day but modified to use the binomial variance for a proportion to estimate the variances of the crude age-specific rates. This method is likely to be unreliable when there are fewer than 50 cases in an area, hence confidence intervals for rates based on less than 50 cases should be viewed with caution. The lower and upper limits for the rates are denoted by DSRLL and DSRUL respectively. (expressed per 100,000 population)where:wi is the number, or proportion, of individuals in the standard population in age group i.rij is the crude age-specific rate in the subject population in age group i, in year j.nij is the number of individuals in the subject population in age group i, in year j.Ref:Breslow NE and Day NE. Statistical Methods in Cancer Research, Volume II: The Design and Analysis of Cohort Studies. Lyon: International Agency for Research on Cancer, World Health Organization, 1987: 59Keyfitz N. Sampling variance of age-standardised mortality rates. Human Biology. 1966; 38: 309-317. |
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