Richard Pascal

Alcohol use and prostate cancer: A meta-analysis

Past reviews have concluded that there is no association between alcohol use and prostate cancer incidence. We performed a meta-analysis of existing epidemiological studies finding, in contrast, evidence to suggest that prostate incidence is positively linearly associated with heavier alcohol use. This finding was largely due to the contribution of population case-control studies and those measuring men recruited before age 60. No relationship between alcohol consumption and prostate cancer was found for cohort and hospital case-control studies. Analyses of design effects modestly suggests that population case-control studies were probably better suited to identify potential alcohol-prostate cancer relationships due to the close temporal proximity of the measurement of level of alcohol consumption to diagnosis. Future efforts should be made to exclude all ill subjects from control groups/baseline samples in addition to accounting for changes in consumption with advancing age and the onset of illness. The alcohol-prostate cancer association remained significant despite controlling for the degree to which studies endeavored to eliminate false negatives from their control groups.

Mortality rate of alcoholic liver disease and risk of hospitalization for alcoholic liver cirrhosis, alcoholic hepatitis and alcoholic liver failure in Australia between 1993 and 2005

Background:  Alcoholic liver disease (ALD) is an important contributor to the total burden of alcohol‐related harm; however, the morbidity of different types of ALD in Australia has not been described. The aim of this study was to investigate recent trends in hospital admission rates among alcoholic liver cirrhosis, alcoholic hepatic failure and alcoholic hepatitis in Australia, as well as the mortality of ALD.

The effect of alcohol sales and advertising restrictions on a remote Australian community

Aim: To evaluate the effect of restricting hours of sale for take-away alcohol, container sizes for beverages linked to risky consumption and advertising and promotion of certain high-strength beverages on community attitudes, consumption and proxy measures of related harm in a small remote community with high levels of problematic use. Methods: Community surveys were undertaken in the intervention community and an adjacent control community immediately prior to the introduction of the mandated restrictions and again 12 months later. Pre and post interviews were conducted with key informants in the intervention community at approximately the same times. Serial consumption and proxy harm data were collected from both intervention and control communities and changes measured over the period that voluntary and then mandatory restrictions were introduced. Findings: There was recognition of a substantial community alcohol problem. This was accompanied by good knowledge of, and support for, the nominated restrictions prior to their mandated introduction. Subsequently, there was little opposition to their ongoing operation. Consumption of the most problematic beverage, cask wine, has reduced. Proxy measures of alcohol harm: night-time hospital accident and emergency occasions of service; trauma-related ambulance call outs; and police-attended disturbances, also declined. Much of this change was associated with earlier, voluntary restrictions. Conclusions: The restrictions have had a beneficial effect, but most of this occurred prior to their mandated introduction. Continuing to mandate compliance is, however, important because it validates community action, crystallizes structural change and provides a basis for further local initiatives.

Risks of alcohol-attributable hospitalisation and death in Australia over time: Evidence of divergence by region, age and sex.

BACKGROUND Past reports on trends of alcohol consumption and related harm have generally been descriptive in nature and have not provided evidence of whether changes over time are significant. AIMS We investigated whether: (i) the risk of alcohol-attributable hospitalisation and death between 1994 and 2005 for three different age groups changed significantly across all Australian jurisdictions; and (ii) the relative rates of hospitalisation for males and females changed over time. METHOD Estimates of alcohol-attributable hospitalisations and deaths were calculated using the aetiologic fraction method. Hospitalisations and deaths were grouped by age: 15-29 years, 30-44 years and 45+ years. Risk estimates and risk differences were analysed using Poisson regression. RESULTS Risk of alcohol-attributable hospital separations increased nationally and across most jurisdictions throughout the study period. Male and female rates converged over time. Alcohol-attributable deaths decreased nationally across the three age groups and across several jurisdictions beginning in the mid-1990s. CONCLUSION Nationally, alcohol-attributable deaths declined while hospitalisations rose. However, states with higher population density tended to drive national rates, with considerable variation by jurisdiction. The conditions which dominated hospitalisations (e.g. alcohol dependence, falls) differed substantially from those underlying alcoholattributable deaths (e.g. alcoholic liver cirrhosis, road crashes). Jurisdictional variation in death and hospitalisations rates as well as changes over time may be partly due to differences in: regulation of alcohol supply; patterns and levels of alcohol consumption; the nature and effectiveness of law enforcement; demographic characteristics of general and sub-populations; and medical health services and screening for chronic conditions.

Australia, the healthiest nation: death, hospital and cost savings of the Preventative Health Taskforce target reductions for alcohol, 2007 to 2020

Background - The National Preventative Health Taskforce has set a 30% target reduction in the proportion of risky and high risk drinkers by 2020. This study estimated the potential saving in deaths, hospitalisations and associated economic cost savings to premature mortality and health of achieving the target. Method - Past national estimates of alcohol-attributable hospitalisations and deaths were used to forecast trends from 2007 to 2020. Estimated potential savings in deaths and hospitalisations were based on incremental decline in the prevalence of risky/high-risk drinking reaching a total of 30% by 2020 (about 2.3% per year). Associated economic costs of premature death were estimated using the Value of Statistical Life method (willingness to pay). Hospital costs were estimated from known trends in annual national costs for recent past years and taking inflation into account. Results - A 30% reduction in risky/high-risk drinkers would avoid an estimated 7,200 deaths and some 94,000 person-years-of-life lost due to premature death by 2020. The estimated benefit to the health sector would include 330,000 fewer hospitalisations and 1.5 million associated bed days. The net present value of these benefits is AUD 22.7 billion from deaths avoided and AUD 1.7 billion from fewer hospital separations totalling AUD 24.4 billion. Conclusion - The potential savings in premature deaths, health and associated financial costs of a 30% reduction in risky and high-risk drinking by 2020 across the Australian population are considerable.