Alcohol, smoking and drugs
Alcohol consumption has doubled in the UK since 1950s and in 2017 it was estimated that more than 29 million people consumed alcohol. Alcohol consumption is a contributing factor to hospital admissions and deaths relating to a wide range of conditions. In 2016/17 across England there were 337,000 hospital admissions primarily due to alcohol consumption while in 2016 there were 5,500 alcohol-specific deaths. It is estimated that the total annual cost of alcohol to the NHS in England and Wales is £3.5 billion and £21 billion to society as a whole.
Adult consumption similar to national levels
It is estimated that over a quarter of Herefordshire adults drink over 14 units of alcohol a week and that one in five binge drink, while one in seven abstain from drinking alcohol. All three local figures are similar to those reported regionally and nationally.
In relation to deprivation 45% of adults in the most deprived areas of Herefordshire abstain from alcohol, a figure appreciably higher than in less deprived areas, although the highest proportion of adults binge drink (22%) is also reported in the most deprived areas of the county; the lowest level of binge drinking (17%) is reported in the least deprived areas of the county.
While the estimated proportion of Herefordshire 15 year olds who have consumed alcohol (73%) is higher than the figure for England as a whole the proportion classed as regular drinkers (7.8%) is similar to the national figure.
Hospital Admissions lower than observed nationally
In 2017/18, there were 682 hospital admissions for alcohol-specific conditions (those caused exclusively by the consumption of alcohol) in Herefordshire, which equates to a rate of 347 per 100,000 population; significantly lower than the rate for both the West Midlands region (528 per 100,000) and England (570 per 100,000). The local admission rate for adults has remained relatively consistent since 2008/09.
The local admission rate for alcohol-specific conditions for those aged under 18 has fallen by almost 60% since 2006/07 and in the period 2015/16 to 2017/18 was 39.9 per 100,000 compared to 32.9 per 100,000 across England and 27.5 in the West Midlands region.
Across Herefordshire individuals from the most deprived areas of the county are over three times as likely to be admitted to hospital due directly to alcohol consumption as those living in the least deprived areas.
In 2015/17 the age-standardised rate of alcohol specific mortality in Herefordshire was 7.9 per 100,000, a figure significantly lower than those reported for both for the West Midlands (13.1 per 100,000) and England as a whole (10.6 per 100,000). The Herefordshire mortality rate has remained relatively stable since 2006/08. As observed nationally and regionally the local male mortality rate (10.7 per 100,000) is approximately twice that for females (5.4 per 100,000).
Smoking is the most important cause of preventable ill health and premature mortality in the UK. Smoking is a major risk factor for many diseases, such as lung cancer, chronic obstructive pulmonary disease (COPD) and heart disease. It is also associated with cancers in other organs, including lip, mouth, throat, bladder, kidney, stomach, liver and cervix.
Adult smoking prevalence falling
Smoking prevalence in Herefordshire has shown a decline in recent years and in 2018 the local figure was 12.6% compared to 17.6% in 2011. Throughout much of this time the local prevalence was lower than that reported for England (Figure 1). In 2018 there were an estimated 19,700 smokers aged 18 and above across Herefordshire.
Figure 1: Smoking prevalence in adults (18+)
Males are a third more likely to smoke than females in Herefordshire while smoking prevalence is lower in rural and semirural areas of the county with higher levels recorded in Hereford and the market towns. Smoking is twice as more prevalent in adults employed in routine and manual occupations in Herefordshire compared to the adult population as a whole.
In 2017/18 the proportion of women in Herefordshire who smoked at the time of delivery was 14.1%, a figure higher than that reported for England as a whole (10.8%) and significantly higher than the “national ambition” of 6%.
The proportion of Herefordshire 15 year olds reporting that they smoked cigarettes in 2014/15 was 5.8%, while 15.1% reported having tried e-cigarettes; these local figures are lower than the corresponding national proportions of 8.2% and 18.4%.
Hospital admissions show little change over last decade
There were almost 2,000 smoking attributable hospital admissions in Herefordshire in 2017/18 which is higher than the annual average since 2009/10. However, the associated local admission rate has shown little change over this time and the 2017/18 figure of 1,480 per 100,000 was similar to that reported nationally.
Smoking related mortality rate continues to fall
Smoking is the biggest single cause of preventable mortality and morbidity in the world and in England accounts for 1 in 6 of all deaths. Over the period 2015-17 there were 915 smoking attributable deaths in Herefordshire which was close to the average for the previous ten years. However, the actual mortality rate fell consistently over this period by 15% and in 2015/17 was 225 per 100,000 a figure lower than that for England (263 per 100,000) – Figure 2.
Figure 2: Smoking attributable mortality rate (35+ years)
Quit rates falling and lower than national figure
While the number of smokers in Herefordshire setting a quit date has continued to fall in recent years, reaching a low of 168 in 2018/19, the actual rate has remained relatively stable since 2015/16, although the local 2018/19 figure of 832 per 100,000 smokers remains lower than that for England as a whole (3,577 per 100,000). The fall in the number setting a quit date mirrors the national pattern and is believed in part to be related to the increased use of e-cigarettes.
Of those setting a quit date in 2018/19 a total of 59 successfully quitted (confirmed by carbon monoxide verification) which corresponds to 35% of those setting a date compared to 36% nationally. However, the Herefordshire local quitting rate of 292 per 100,000 smokers is considerable lower than that reported nationally (1,305 per 100,000) and continues a downward trend observed locally (Figure 3).
Figure 3: Smokers successfully quitting at 4 weeks (CO validated)
Prolonged or regular drug misuse can cause short and long-term physical and mental health problems. Drug overdoses can result in permanent health damage or death. Some drugs are highly addictive and addicts are more likely to become perpetrators or victims of crime and experience a wide range of social problems, such as homelessness, relationship breakdown and unemployment. Those who use needles can put themselves at a higher risk of exposure to blood-borne viruses such as HIV/AIDS and hepatitis.
Opiate and crack cocaine use lower than nationally
In 2016/17 there were an estimated 719 opiate and/or crack cocaine users in Herefordshire which corresponds to a prevalence of 6.3 per 1,000 population which is significantly lower than that for England as a whole (8.9 per 1,000).
The proportion of those opiate users in Herefordshire undergoing drug treatment in 2017 who successfully completed treatment (8.1%) was higher than the national figure (6.5%), although not significantly so. In relation to non-opiate users the rate for successfully completing drug treatment was 27.8% locally, which was significantly lower than the England rate of 36.9%.
Drug misuse related mortality similar to national rate
Since 2006-08 over each three year period there have been on average 18.8 deaths related to drug misuse deaths; for the period 2016-2018 the figure was 19. This latter number corresponds to a mortality rate of 3.6 per 100,000 which was lower than that for England (4.5 per 100,000) although not significantly so.