More than 5,500 excess deaths from alcohol-related liver disease occurred in England between March 2020 and December 2024, according to a new study analysing two decades of data. The largest increase occurred in people with no recent hospital care. The study is published in the Journal of Epidemiology and Community Health.
Researchers from Oxford Population Health's Applied Health Research Unit examined national mortality records linked to NHS hospital data for all deaths from alcohol-related liver disease (ARLD) among adults aged 25 to 84 in England, from January 2004 to December 2024. The study is the first to examine trends in ARLD deaths by whether people had recent contact with hospital care before they died.
ARLD deaths were drawn from Office for National Statistics mortality records linked to Hospital Episode Statistics and Admitted Patient Care records collected and supplied by NHS England. The team used these data to investigate how mortality changed after the onset of the COVID-19 pandemic in March 2020, and compare trends between people who died in hospital and those who died outside it.
Key findings:
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97,058 people died from ARLD between January 2004 and December 2024, with about a third of these deaths occurring outside hospital. More than half (56%) of the people who died had no hospital-recorded ARLD diagnosis and more than one-third (36%) had no inpatient care in the year preceding their death;
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Following the onset of the pandemic, ARLD mortality rose by 27.7%, equivalent to 5,571 excess deaths between March 2020 and December 2024;
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The rise was steeper for deaths outside hospital (34.9%) than for deaths in hospital (22.9%);
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The increase in out-of-hospital deaths was driven largely by people who had no hospital admission of any kind in the year before they died, among whom mortality rose by 75.7%;
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Mortality remained highest in men, middle-aged adults, people living in more deprived areas, and those in the North East and North West of England, both before and after the pandemic.
Emre Oguzman, Health Data Epidemiologist at Oxford Population Health and first author of the study, said:
‘We already knew that ARLD has consistently been marked by missed opportunities for timely intervention, and the pandemic disrupted access for managing alcohol misuse. But what's striking is where this increase in deaths from ARLD is concentrated.
While most ARLD deaths still occur among people with recent hospital contact, the sharpest rise has been among people with no recent hospital contact at all. That points to worsening gaps in how we're identifying and reaching people with harmful drinking patterns.
The authors say the findings suggest that pandemic-related disruption to health services, alongside pre-existing pressures on specialist alcohol treatment services, may have made it harder for people with harmful drinking patterns to access support. They call for further research into how this group engages with health care services, greater community-level outreach, and renewed public health measures such as stricter alcohol marketing regulation and minimum unit pricing.
The research team has also developed an online dashboard to provide near real-time, monthly monitoring of ARLD mortality trends across England.
This study was supported by the National Institute for Health and Care Research Biomedical Research Centre: Oxford and Health Data Research UK.