Alcohol-related and hepatocellular cancer deaths by country of birth in England and Wales: analysis of mortality and census data.
BACKGROUND
The incidence of and mortality from alcohol-related conditions, liver disease and hepatocellular cancer (HCC) are increasing in the UK. We compared mortality rates by country of birth to explore potential inequalities and inform clinical and preventive care.


METHODS
Analysis of mortality for people aged 20 years and over using the 2001 Census data and death data from 1999 and 2001-2003.


METHODS
England and Wales.


METHODS
Standardized mortality ratios (SMRs) for alcohol-related deaths and HCC.


RESULTS
Mortality from alcohol-related deaths (23 502 deaths) was particularly high for people born in Ireland (SMR for men [M]: 236, 95% confidence interval [CI]: 219-254; SMR for women [F]: 212, 95% CI: 191-235) and Scotland (SMR-M: 187, CI: 173-213; SMR-F 182, CI: 163-205) and men born in India (SMR-M: 161, CI: 144-181). Low alcohol-related mortality was found in women born in other countries and men born in Bangladesh, Middle East, West Africa, Pakistan, China and Hong Kong, and the West Indies. Similar mortality patterns were observed by country of birth for alcoholic liver disease and other liver diseases. Mortality from HCC (8266 deaths) was particularly high for people born in Bangladesh (SMR-M: 523, CI: 380-701; SMR-F: 319, CI: 146-605), China and Hong Kong (SMR-M: 492, CI: 168-667; SMR-F: 323, CI: 184-524), West Africa (SMR-M: 440, CI, 308-609; SMR-F: 319, CI: 165-557) and Pakistan (SMR-M: 216, CI: 113-287; SMR-F: 215, CI: 133-319).


CONCLUSIONS
These findings show persistent differences in mortality by country of birth for both alcohol-related and HCC deaths and have important clinical and public health implications. New policy, research and practical action are required to address these differences.
Bhala
Neeraj
N
Department of Gastroenterology, University Hospital of Coventry & Warwickshire, Walsgrave, Coventry CV2 2DX, UK. neeraj.bhala@ctsu.ox.ac.uk
Bhopal
Raj
R
Brock
Anita
A
Griffiths
Clare
C
Wild
Sarah
S
D000328:Adult; D000437:Alcoholism / Q000150:complications* / Q000208:ethnology; D006528:Carcinoma, Hepatocellular / Q000139:chemically induced* / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality*; D019352:Censuses; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000139:chemically induced* / Q000208:ethnology / Q000401:mortality*; D008297:Male; D014852:Wales / Q000453:epidemiology; D055815:Young Adult