Socioeconomic status is the economic and social position of an individual in relation to others based on education, income, occupation, etc. In several developed countries, including the UK, individuals of high socioeconomic status appear to consume just as much alcohol as individuals of lower socioeconomic status, yet alcohol is more likely to cause disease and death in those of lower socioeconomic status. Alcoholic liver disease is one of the leading causes of alcohol-related mortality. The disease is usually preceded by years of heavy drinking, and symptoms can be vague until life-threatening complications develop. This project will evaluate factors that contribute to an increased risk of death among patients with alcoholic liver disease of low compared to high socioeconomic status.
We will investigate whether low socioeconomic status is associated with a more advanced disease stage at diagnosis. The disease stage at diagnosis of alcoholic liver disease is a strong predictor of death. For instance, 17% of patients with no complications compared to 50% with multiple complications at their initial diagnosis were dead after one year.
After a diagnosis of alcoholic liver disease, patients of low socioeconomic status may receive less preventive health care such as a lower rate primary care visits, less diagnostic testing, and less specialist care. For example, studies found that cancer patients with low socioeconomic status had less diagnostic testing and were more likely to receive suboptimal cancer treatment than patients with high socioeconomic status.
Alcoholic liver disease is a life-threatening condition causing a large fraction of all alcohol-related deaths. In several countries including the UK, people of high socioeconomic status consume just as much alcohol as people of lower socioeconomic status, yet alcohol causes more death and disease in the latter.
We will combine data from registers of primary care contacts, hospital episode statistics, diagnostic imaging, cause of death, and individual socioeconomic status measured as patient-level deprivation index. We will investigate if a more advanced disease stage at diagnosis or/and differences in health care can explain the increased mortality from alcoholic liver disease associated with low socioeconomic status.
We will compare the risk of an advanced disease stage at diagnosis with alcoholic liver disease according to socioeconomic status, controlling for confounding from comorbidity and lifestyle factors. We will compute all-cause and cause-specific mortality rates according to disease stage and socioeconomic status at diagnosis with alcoholic liver disease.
Among patients with advanced alcoholic liver disease, we will assess rates of health care (primary care visits, planned/unplanned hospital care, and diagnostic testing associated with liver disease) according to socioeconomic status. We will then examine whether the higher mortality in patients with low compared to high socioeconomic position can be partly explained by differences in health care, lifestyle factors, and/or comorbidity, including psychiatric comorbidity.
Information provided from these studies should help us design preventive interventions for alcoholic liver disease in groups of lower socioeconomic status. For example, population screening could target people of lower socioeconomic status if our research shows that such people tend to be diagnosed in a later disease stage. Our results on differences in health care after diagnosis of alcoholic liver disease may reveal whether we need stronger efforts to promote health care among groups of lower socioeconomic status.
Odds ratios for advanced disease stage at diagnosis of alcoholic liver disease according to socioeconomic status.
Survival time and cause-specific mortality according to disease stage at diagnosis of alcoholic liver disease and socioeconomic status.
Estimate incidence rates of health care (primary care visits, acute admissions associated to liver disease, upper endoscopy, diagnostic imaging, and specialist care) according to socioeconomic status.
Risk estimates for mortality among patients with alcoholic liver cirrhosis according to socioeconomic status, psychiatric comorbidity, and stratified by disease stage and adjusted for health care, comorbidity, and life-style factors.
Colin Crooks - Chief Investigator - University of Nottingham
Gro Askgaard - Corresponding Applicant - Aarhus University Hospital
Anna Emilie Kann - Collaborator - Aarhus University Hospital
Harmony Otete - Collaborator - University Of Central Lancashire
Joanne Morling - Collaborator - University of Nottingham
Joe West - Collaborator - University of Nottingham
Kate Fleming - Collaborator - University of Liverpool
Peter Jepsen - Collaborator - Aarhus University Hospital
Timothy Card - Collaborator - University of Nottingham
HES Accident and Emergency;HES Admitted Patient Care;HES Diagnostic Imaging Dataset;Mental Health Services Data Set (MHSDS);ONS Death Registration Data;Patient Level Index of Multiple Deprivation