Potential working years of life lost (PWYLL) due to alcohol-related conditions - WMCA

Potential working years of life lost (PWYLL) due to alcohol-related conditions, ages 16-64, directly age-standardised per 100,000 population. ## Rationale Alcohol consumption is a contributing factor to hospital admissions and deaths from a diverse range of conditions. The Government has said that everyone has a role to play in reducing the harmful use of alcohol - this indicator is one of the key contributions by the Government (and the Department of Health and Social Care) to promote measurable, evidence-based prevention activities at a local level, and supports the national ambitions to reduce harm set out in the Government's Alcohol Strategy. This ambition is part of the monitoring arrangements for the Responsibility Deal Alcohol Network. Alcohol-related deaths can be reduced through local interventions to reduce alcohol misuse and harm. Years of life lost is a measure of premature mortality. The purpose of this measure is to estimate the length of time a person would have lived had they not died prematurely. As the calculation includes the age at which death occurs, it is an attempt to quantify the burden on society from the specified cause of mortality. Alcohol-related deaths often occur at relatively young ages. One of the ways to consider the full impact of alcohol on both the individual and wider society is to look at how many working years are lost each year due to premature death as a result of alcohol. To enable comparisons between areas and over time, PWYLL rates are age-standardised to represent the PWYLL if each area had the same population structure as the 2013 European Standard Population (ESP). PWYLL rates are presented as years of life lost per 100,000 population. ## Definition of numerator The number of years between a death due to alcohol-related conditions in those aged 16 to 64 years and the age of 65 years. Deaths from alcohol-related conditions are extracted and assigned an alcohol attributable fraction based on underlying cause of death (and all cause of deaths fields for the conditions: ethanol poisoning, methanol poisoning, toxic effect of alcohol). Mortality data includes all deaths registered in the calendar year where the local authority of usual residence of the deceased is one of the English geographies and an alcohol attributable diagnosis is given as the underlying cause of death. After application of the alcohol-attributable fractions, the number of deaths at each age between 16 and 64 is summed, multiplied by the years remaining to 65, and then aggregated into quinary age bands. References: * PHE (2020) Alcohol-attributable fractions for England: an update [https://www.gov.uk/government/publications/alcohol-attributable-fractions-for-england-an-update] ## Definition of denominator ONS Mid-Year Population Estimates aggregated into quinary age bands. ## Caveats There is the potential for the underlying cause of death to be incorrectly attributed on the death certificate and the cause of death misclassified. Alcohol-attributable fractions were not available for children. Conditions where low levels of alcohol consumption are protective (have a negative alcohol-attributable fraction) are not included in the calculation of the indicator. Where the observed total number of deaths is less than 10, the rates have been suppressed as there are too few deaths to calculate PWYLL directly standardised rates reliably. The cut off has been reduced from 25, following research commissioned by PHE and in preparation for publication which shows DSRs and their confidence intervals are robust whenever the count is at least 10. The confidence intervals do not take into account the uncertainty involved in the calculation of the AAFs – that is, the proportion of deaths that are caused by alcohol and the alcohol consumption prevalence that are included in the AAF formula are only an estimate and so include uncertainty. The confidence intervals published here are based only on the observed number of deaths and do not account for this uncertainty in the calculation of attributable fraction - as such the intervals may be too narrow.