title: Investigation of the Association Between Alcohol Outlet Density and Alcohol-Related Hospital Admission Rates in England: Study Protocol.
abstract: BACKGROUND
  Availability of alcohol is a major policy issue for governments, and one of the availability factors is the density of alcohol outlets within geographic areas.
  
  
  OBJECTIVE
  The aim of this study is to investigate the association between alcohol outlet density and hospital admissions for alcohol-related conditions in a national (English) small area level ecological study.
  
  
  METHODS
  This project will employ ecological correlation and cross-sectional time series study designs to examine spatial and temporal relationships between alcohol outlet density and hospital admissions. Census units to be used in the analysis will include all Lower and Middle Super-Output Areas (LSOAs and MSOAs) in England (53 million total population; 32,482 LSOAs and 6781 MSOAs). LSOAs (approximately 1500 people per LSOA) will support investigation at a fine spatial resolution. Spatio-temporal associations will be investigated using MSOAs (approximately 7500 people per MSOA). The project will use comprehensive coverage data on alcohol outlets in England (from 2003, 2007, 2010, and 2013) from a commercial source, which has estimated that the database includes 98% of all alcohol outlets in England. Alcohol outlets may be classified into two broad groups: on-trade outlets, comprising outlets from which alcohol can be purchased and consumed on the premises (eg, pubs); and off-trade outlets, in which alcohol can be purchased but not consumed on the premises (eg, off-licenses). In the 2010 dataset, there are 132,989 on-trade and 51,975 off-trade outlets. The longitudinal data series will allow us to examine associations between changes in outlet density and changes in hospital admission rates. The project will use anonymized data on alcohol-related hospital admissions in England from 2003 to 2013 and investigate associations with acute (eg, admissions for injuries) and chronic (eg, admissions for alcoholic liver disease) harms. The investigation will include the examination of conditions that are wholly and partially attributable to alcohol, using internationally standardized alcohol-attributable fractions.
  
  
  RESULTS
  The project is currently in progress. Results are expected in 2017.
  
  
  CONCLUSIONS
  The results of this study will provide a national evidence base to inform policy decisions regarding the licensing of alcohol sales outlets.
authors.affiliation: Public Health GIS Unit, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Ravi
authors.identifier: http://orcid.org/0000-0002-3899-4421
authors.initials: R
authors.lastname: Maheswaran
authors.affiliation: Sheffield Alcohol Research Group, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
authors.forename: John
authors.identifier: http://orcid.org/0000-0001-9283-2151
authors.initials: J
authors.lastname: Holmes
authors.affiliation: Public Health GIS Unit, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Mark
authors.identifier: http://orcid.org/0000-0002-0942-6628
authors.initials: M
authors.lastname: Green
authors.affiliation: Public Health GIS Unit, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Mark
authors.identifier: http://orcid.org/0000-0003-1486-8233
authors.initials: M
authors.lastname: Strong
authors.affiliation: Public Health GIS Unit, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Tim
authors.identifier: http://orcid.org/0000-0001-9791-3655
authors.initials: T
authors.lastname: Pearson
authors.affiliation: Sheffield Alcohol Research Group, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Petra
authors.identifier: http://orcid.org/0000-0001-5354-1933
authors.initials: P
authors.lastname: Meier
keywords: admissions; alcohol; epidemiology; geography; hospital; outlets