Drinking 10 drinks a week reduces life expectancy by up to 2 years

Cambridge University | April 2018 | Drinking more than five pints a week could shorten your life, study finds

The latest edition of The Lancet includes research from Cambridge University that has been funded by NIHR, the British Heart Foundation and other partners. Dr  Angela Wood the lead author of the study said: “Alcohol consumption is associated with a slightly lower risk of non-fatal heart attacks but this must be balanced against the higher risk associated with other serious – and potentially fatal – cardiovascular diseases.”
The authors of the study found that an increased intake of alcohol  is associated with a higher risk of stroke, fatal aneurysm, heart failure and death (via Cambridge University).
bottles-2357645_1920The researchers found that intake of 10 or more alcoholic drinks per week was linked with one to two years shorter life expectancy.  For those drinking 18 or more drinks per week  life expectancy was around four to five years shorter. For this reason the authors  say their findings challenge the belief that moderate drinking is beneficial to cardiovascular health, and support the UK’s recently lowered guidelines on alcohol consumption. 

Summary

Background

Low-risk limits recommended for alcohol consumption vary substantially across different national guidelines. To define thresholds associated with lowest risk for all-cause mortality and cardiovascular disease, we studied individual-participant data from 599 912 current drinkers without previous cardiovascular disease.

Methods

We did a combined analysis of individual-participant data from three large-scale data sources in 19 high-income countries (the Emerging Risk Factors Collaboration, EPIC-CVD, and the UK Biobank). We characterised dose–response associations and calculated hazard ratios (HRs) per 100 g per week of alcohol (12·5 units per week) across 83 prospective studies, adjusting at least for study or centre, age, sex, smoking, and diabetes. To be eligible for the analysis, participants had to have information recorded about their alcohol consumption amount and status (ie, non-drinker vs current drinker), plus age, sex, history of diabetes and smoking status, at least 1 year of follow-up after baseline, and no baseline history of cardiovascular disease. The main analyses focused on current drinkers, whose baseline alcohol consumption was categorised into eight predefined groups according to the amount in grams consumed per week. We assessed alcohol consumption in relation to all-cause mortality, total cardiovascular disease, and several cardiovascular disease subtypes. We corrected HRs for estimated long-term variability in alcohol consumption using 152 640 serial alcohol assessments obtained some years apart (median interval 5·6 years [5th–95th percentile 1·04–13·5]) from 71 011 participants from 37 studies.

Findings

In the 599 912 current drinkers included in the analysis, we recorded 40 310 deaths and 39 018 incident cardiovascular disease events during 5·4 million person-years of follow-up. For all-cause mortality, we recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk around or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke (HR per 100 g per week higher consumption 1·14, 95% CI, 1·10–1·17), coronary disease excluding myocardial infarction (1·06, 1·00–1·11), heart failure (1·09, 1·03–1·15), fatal hypertensive disease (1·24, 1·15–1·33); and fatal aortic aneurysm (1·15, 1·03–1·28). By contrast, increased alcohol consumption was log-linearly associated with a lower risk of myocardial infarction (HR 0·94, 0·91–0·97). In comparison to those who reported drinking  greater than 0–less than or equal to 100 g per week, those who reported drinking more than 100– less than or equal to 200 g per week,  more than 200– less than or equal to 350 g per week, or  greater than 350 g per week had lower life expectancy at age 40 years of approximately 6 months, 1–2 years, or 4–5 years, respectively.

Interpretation

In current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about 100 g/week. For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. These data support limits for alcohol consumption that are lower than those recommended in most current guidelines.

The full article may be downloaded from The Lancet 

Full reference:
Wood, A, M., M et al. |Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies |The Lancet | Vol. 391| Issue 10129 | P. 1513 – 1523 | DOI: https://doi.org/10.1016/S0140-6736(18)30134-X

 

In the media:

BBC News  Regular excess drinking can take years off your life, study finds

 

Student suicide rate has increased between 2007-2016 and overtaken suicides among the general population

Times Higher Education | April 2018 | UK student suicide rate ‘rises by 56 per cent in 10 years’

For the first time the incidence of suicide in  UK students has superseded the rate among non-students. New figures released by the Centre for Suicide Research and Prevention at Hong Kong University show in the decade to 2016 the suicide rate in UK students increased by 56 per cent (from 6.6 to 10.3 per 100,000).  The risk of suicide in female students was a fifth higher in 2016 compared with women across all ages of the general population.  ONS figures show that the average suicide rate among the general population of 15-19 year olds was 5.9, while the rate for 20-24 year-olds was 10.4 (via Times Higher Education).

window-view-1081788_1920

The number of university students increased by 5 per cent between 2012 and 2016, the total number of suicides rose by 32 per cent (from 139 to 183).  However, the researchers, argue that their findings refute claims that the increase in the number of student suicides might be explained by a rise in the number of students.

Edward Pinkney, researcher at the Centre for Suicide Research and Prevention at HKU and co-author of the analysis, said that concerns about students’ mental health have been increasing since the economic recession, but “until now there has been no comprehensive analysis of UK student suicide data”.

“This is the first time we can conclusively say that as far as suicide is concerned, there is a real problem in higher education,” he said.

The researchers  will present their findings next month, at the International Association for Suicide Prevention’s annual conference in New Zealand.

The full news story can be read at Times Higher Education 

In the media:

BBC News Student suicide rates overtake non-students

The Telegraph Universities have a suicide problem as students taking own lives overtakes general population

 

COPD National Audit Programme

Health Quality Improvement Programme | April 2018 | National COPD Audit Programme COPD: Time to Integrate care 

The Health Quality Improvement Programme (HQIP) has published two relating to the National Chronic Obstructive Pulmonary Disease Audit.

COPD
Image source: hqip.org.uk

COPD: Time to integrate care

The report presents the results from a snapshot audit of the organisation and resourcing of COPD care that was undertaken in hospitals in England and Wales in the spring of 2017. The report makes a number of recommendations, among them the need to:

• reduce the rise in admissions, where it is possible to do so
• improve access to hospital- and community-based respiratory care (including over weekends)
• develop more effective cross-sector working and integration of COPD services.

The report can be downloaded from HQIP here

Health Quality Improvement Programme | April 2018 | National COPD Audit Programme: Pulmonary rehabilitation: An exercise in improvement 

COPD National report 2018: Pulmonary rehabilitation, an exercise in improvement

Pulmonary rehabilitation (PR) is one of the most effective and high value interventions for people suffering with COPD. This report presents the second round of both clinical and organisational PR audits, which follow the first rounds conducted in 2015.

copd audit
Image source: hqip.org.uk

The report summarises key findings, and priorities for quality improvement presented under three broad categories:

  • access to PR
  • quality of PR services
  • outcomes of treatment

It also highlights successes

  • rates of completion have improved marginally to 62% in 2017 compared with 59% reported in 2015
  • improvements in the provision of written discharge exercise plans (84% in 2017 versus 65% in 2015),
  • the assessment of muscle strength (27% in 2017 versus 15% in 2015) and in the numbers of programmes with a written standard operating procedure (84% in 2017 versus 67% in 2015).

The report can be downloaded from HQIP here 

 

National Diet and Nutrition Survey updated

Public Health England | April 2018 | National Diet and Nutrition Survey Results from Years 7 and 8 (combined) of the Rolling Programme (2014/2015 to 2015/2016)

The National Diet and Nutrition Survey Rolling Programme (NDNS RP) is a continuous programme of fieldwork designed to assess the diet, nutrient intake and nutritional status of the general population aged 1.5 years and over living in private households in the UK. The core NDNS RP is jointly funded by Public Health England (PHE)1 and the UK Food Standards Agency (FSA).

dinner plateNDNS provides essential evidence on the diet and nutrition of the UK population to enable PHE to identify and address nutritional issues in the population and monitor progress towards public health nutrition objectives.

The report can be downloaded here 

The supporting documents can be viewed at Public Health England

“Good cholesterol” associated with raised risk of infectious diseases, according to Danish researchers

Scientists in Copenhagen have discovered that patients with both low and high rates of HDL, the so-called good cholesterol, had a higher risk of being hospitalised with an infectious disease; they also had an increased risk of dying from an infectious disease.

These findings  were based on analysis of data from 100,000 individuals from the Copenhagen General Population Study who were followed for over 6 years using national Danish health registries. The paper has just been published in the European Heart Journal (via Science Daily).

Abstract

Aims

Preclinical evidence has indicated that HDL may play an important role in the immune system; however, very little is known about the role of HDL in the immune system in humans. We tested the hypothesis that low and high concentrations of HDL cholesterol are associated with risk of infectious disease in the general population.

Methods and results

We included 97 166 individuals from the Copenhagen General Population Study and 9387 from the Copenhagen City Heart Study with measurements of HDL cholesterol at baseline. The primary endpoint was any infectious disease requiring hospital admission, ascertained in the Danish health registries from baseline in 2003–13 or 1991–94 through 2014; 9% and 31% of individuals in the two studies experienced one or more infectious disease events. Using restricted cubic splines, there was a U-shaped association between concentrations of HDL cholesterol and risk of any infection. Following multifactorial adjustment, individuals with HDL cholesterol below 0.8 mmol/L (31 mg/dL) and above 2.6 mmol/L (100 mg/dL) had hazard ratios for any infection of 1.75 (95% confidence interval 1.31–2.34) and 1.43 (1.16–1.76), compared to those with HDL cholesterol of 2.2–2.3 mmol/L (85–95 mg/dL). In the Copenhagen City Heart Study, corresponding hazard ratios for any infection were 2.00 (1.16–3.43) and 1.13 (0.80–1.60).

Conclusion

Low and high HDL cholesterol concentrations found in 21% and 8% of individuals were associated with higher risk of infectious disease in the general population. These findings do not necessarily indicate causality.
Full reference:

Madsen, : C, M.  Varbo, A.,  Tybjærg-Hansen, A., Frikke-Schmidt, R., G Nordestgaard, B, G., |  U-shaped relationship of HDL and risk of infectious disease: two prospective population-based cohort studies |  European Heart Journal |  Vol. 39 | Issue 14 |  7 April 2018 | P. 1181–1190, https://doi.org/10.1093/eurheartj/ehx665

The full article is available for Rotherham NHS staff to request here 

UK Drug Situation: Focal Point annual report

Public Health England, Home Office, Welsh Government, The Scottish Government, Public Health Wales & Department of Health (Northern Ireland)| April 2018 | United Kingdom drug situation: Focal Point annual report 2017

Research and analysis into the drug situation in the UK reveals that prevalence in the general population is lower than a decade ago. Cannabis continues to be the most widely used, followed by powder cocaine and ecstasy/ MDMA. Data from the surveys in England and Scotland shows that prevalence in schoolchildren in has increased, which is in contrast to a previously reported steady decline among this age range.

  • drug situation
    Image source: assets.publishing.service.gov.uk

    There were almost 120,000 (119,973) treatment presentations in the UK in 2016. In England and Wales, 244,971 individuals were recorded as being in drug treatment during 2016. Of those in treatment in England and Wales, 138,422 were receiving prescribing treatment for opioid use.

  • In the UK, two-fifths (42%) of treatment presentations in the UK were for primary heroin use, with  a quarter (25%) of all service users presenting for treatment of cannabis use. Among those who had never previously been in treatment, 45% of clients presented for primary cannabis use, whereas 16% presented for primary heroin use, representing a five per cent decrease in the proportion of first-time primary heroin clients from 2015. (Executive Summary)

The full analysis is available here

Infectious diseases in pregnancy screening

Public Health England | April 2018 | Infectious diseases in pregnancy screening: programme standards

The Infectious Diseases in Pregnancy Screening (IDPS) Programme aims to support
health professionals and commissioners in providing a high quality screening
programme. This involves the development and regular review of quality standards
against which data is collected and reported annually. The standards provide a defined set
of measures that providers have to meet to ensure local programmes are safe and
effective. 

autumn-1850044_1920

The most recent standards apply to data collected from 1 April 2018. They replace previous versions.  Public Health England (PHE) present the national screening standards for the NHS infectious diseases in pregnancy screening (IDPS) programme in the following documents (PHE).

The standards can be downloaded by following the link