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Alcohol dependence (Indicator 5)

Published


The indicator describes the following: Alcohol related morbidity and mortality.


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This indicator is part of Target (2): At least a 10 per cent reduction in harmful alcohol consumption.

To determine the proportion of individuals with alcohol dependency, interviews must be conducted among the general population. Such a population study is being planned as part of the Health Survey in Nord Trøndelag (HUNT)

The Cause of Death Registry provides data on the number of alcohol-related deaths.

The national health registries for the primary and specialist health services describe the proportion of individuals with alcohol-related illnesses who have been detected by the health service, and therefore provide data on the frequency of contact with the health service regarding alcohol-related illnesses.

Results

The annual number of alcohol-related deaths has remained stable during the period 2006-2015. Less than half of these deaths were due to chronic alcohol dependence (Figure 1).

alcohol-related deaths NCD.jpg

Figure 1:Number of alcohol-related deaths per year in a five-year moving average. The data are not age-standardised. Source: Cause of Death Registry, Norwegian Institute of Public Health. See Table 1. 

In comparison, approximately 6 out of 1000 of the population were in contact with primary or specialist health services due to chronic alcohol dependence or harmful use of alcohol in 2014. This is shown by data collected from the Norwegian Patient Registry and from the Norway Control and Payment of Health Reimbursements (KUHR) Database for 2014. 

Data sources 

The data sources for this indicator are the Cause of Death Registry, the Norwegian Patient Registry and the Norway Control and Payment of Health Reimbursements (KUHR) Database. 

Results from other data sources will be published at a later date: A diagnosis-based population survey of mental health conditions and drug and alcohol-related illnesses connected to HUNT4 is planned for 2018

Descriptions and definitions of the Cause of Death Registry, the Norwegian Patient Registry and the Norway Control and Payment of Health Reimbursements (KUHR) Database follow below.

Data source: Cause of Death Registry

Description 

The cause of death statistics are compiled on the basis of death certificates completed by public sector doctors. In addition, information is obtained from the Norwegian Cancer Registry, the Medical Birth Registry of Norway, hospital autopsy results and forensic examinations.

Link: Cause of Death Registry

The following ICD10 diagnosis codes are included for alcohol-related deaths: 

  • Mental and behavioural disorders due to use of alcohol (F10), the diagnosis F10.2 alcohol dependence, was the most important underlying cause of death in this group as at 2016
  •  Damage to the nervous system due to alcohol (G32.1, G62.1, G72.1)
  •  Alcoholic cardiomyopathy (I42.6)
  •  Alcoholic gastritis (K29.2)
  •  Alcoholic liver disease (K70)
  •  Alcohol-induced pancreatitis (K85.2, K86.0)
  •  Fetal alcohol syndrome (Q86.0)
  •  Other alcohol-induced damage (E24.4, P04.3)
  •  Poisoning by and exposure to alcohol (X45, Y15)
  •  Intentional self-poisoning by and exposure to alcohol (X65)

Effect measure 

  • Number of alcohol-related deaths per year in a five-year moving average. Here, the changing nature of the population’s size and age distribution over time is not taken into account. 

Interpretation and sources of error

Alcohol-related mortality includes three main groups: Death due to chronic alcohol dependence, death due to alcohol poisoning and death due to disease in internal organs as a result of alcohol abuse. Where there are no specific diagnoses connected to cases of alcohol abuse, “chronic alcohol dependence” is often used as an underlying cause of death.  

Data quality

The data quality is deemed to be generally good. However, the number of autopsies being performed is declining steadily, making quality assurance of diagnoses difficult.  

Data source: Norwegian Patient Registry

Description 

The Norwegian Patient Registry contains health data on patients who have received or are waiting for treatment via the specialist health service.

Link: Norwegian Patient Registry

Here, data on alcohol dependence from 2014 is provided as an example of the use of data from the Norwegian Patient Registry.

Effect measure

The number of patients per 1000 population who have been in contact with the specialist health service in the course of 2014 where the following ICD-10 diagnoses were given:

  • F10.1: Harmful use of alcohol
  • F10.2 : Chronic alcohol dependence

Data source: Norway Control and Payment of Health Reimbursements (KUHR) Database

Description 

The settlement system for the Norway Control and Payment of Health Reimbursements (KUHR) Database has been established to manage financial arrangements for GPs and other health personnel performing services that are reimbursed under the National Insurance scheme. Diagnoses are given at the level of the individual for every patient encounter.

Data from 2014 on chronic alcohol dependence are provided here as an example of the use of data from KUHR.

Effect measure

The number of patients per 1,000 population who have been in contact with the primary health service during the course of 2014 where the following ICD-II diagnoses were given:

  • P15: Chronic alcoholism

Table accompanying the figure

 

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

Chronic alcohol dependence

166

168

167

177

179

181

175

173

159

151

149

Alcoholic liver disease and alcoholic cardiomyopathy

161

156

143

145

152

148

150

144

144

143

145

Alcohol poisoning

42

38

40

41

41

41

45

42

40

39

40

Other deaths due to alcohol abuse

10

13

14

14

14

14

14

13

15

15

17

Total deaths due to alcohol use

380

375

364

378

387

383

384

371

357

347

351

Table 1: Number of alcohol-related deaths per year in a five-year moving average. The data do not take the age distribution and size of the population into account.  The chronic alcohol dependence category also includes other behavioural disorders due to use of alcohol. Source: Cause of Death Registry, Norwegian Institute of Public Health. 

National adaptation to global indicators

WHO’s definition of the indicator

Indicator 5. Alcohol-related morbidity and mortality among adolescents and adults, as appropriate, within the national context. 

National adaptation

WHO has defined alcohol-related morbidity and mortality based on the diagnosis codes F10.1 Alcohol abuse and F10.2 Alcohol dependence, both of which are in the group “F10 Alcohol related disorders”. 

In Norway, “chronic alcohol dependence” is often stated as an underlying cause of death in the absence of more specific diagnoses connected to a case of alcohol abuse. Thus, in the Norwegian national context, inclusion of deaths due to alcohol poisoning and deaths due to disease in internal organs as a result of alcohol abuse is relevant when the aim is to show data on mortality related to alcohol consumption.

Authors and contacts

Text compiled by the Department of Non-communicable Diseases and the Cause of Death Registry, Norwegian Institute of Public Health in collaboration with the Municipal Patient and User Registry (KPR) at the Norwegian Directorate of Health, Department of Health Management and Health Economics.