Estimating the long-term health impacts of changes in alcohol consumption during the COVID-19 pandemic

Research question What is the potential longer-term indirect effect of COVID-19 on alcohol harm in England?

Background Between one-fifth and one-third of adults are drinking more than before the pandemic, with a similar proportion drinking less. There is some evidence that heavier drinkers pre-COVID-19 have increased their consumption the most.

Healthcare utilisation has reduced during COVID-19, bringing a risk that alcohol harm could worsen but become less visible. The Royal College of Psychiatrists has warned addiction services could be overwhelmed by post-pandemic demand. Alcohol harm includes morbidity and mortality, healthcare costs, and wider social consequences.

The longer-term indirect effect of COVID-19 on alcohol use and harm is unknown.

Our research fills this gap using microsimulation models, considering several scenarios, accounting for ongoing uncertainty in COVID-19 restrictions and drinking patterns.

Aims and objectives Aims: 1) estimate future health, social and economic impacts of changes in alcohol consumption observed during COVID-19; 2) mitigate future alcohol harm by developing and disseminating recommendations to policymakers and stakeholders.

Objectives: Simulate the future impact of recent changes in alcohol consumption on alcohol harm for the following alcohol consumption scenarios (2020 to 2035): Baseline: pre-2020 trends continue Short-term: trends between March 2020 and the most up-to-date data available are used, before reverting to baseline Medium-term: current trends remain for two years, before reverting to baseline Permanent impact: current trends continue Estimate the impact on alcohol-related morbidity and mortality, hospitalisations, harm and costs by age-group, sex and socio-economic status (SES), to gauge indirect effects of COVID-19 on alcohol-related inequalities Develop and disseminate recommendations to influence policy and minimise future alcohol harm.

Methods We will adapt our validated microsimulation model with relevant data: 1) Population module (ONS population estimates); 2) Risk factor module (alcohol sales/Alcohol Toolkit Study); 3) Disease epidemiology module (incidence/prevalence, hospitalisations, mortality and survival for various alcohol-related conditions); 4) Health economic/indirect impacts module (annual costs per case; risk of wider alcohol harm e.g. suicide/domestic violence); 5) Intervention module.

Model outputs include age-, sex- and SES-disaggregated estimates of: annual premature mortality, alcohol-related disease incidence, alcohol-related hospitalisations and healthcare costs.

Timelines Months 1-2 involve consultation with patient and public involvement (PPI) representatives, refinement/testing of scenarios, collating and inputting data.

Months 2-5 include modelling, analysis and writing up, with preliminary results and recommendations consulted on at a PPI workshop in month 4. Results will be disseminated in month 6.

Anticipated impact and dissemination Policy recommendations are likely to highlight alcohol-related healthcare needs, and population-level policy solutions e.g. pricing, marketing and availability.

Alcohol is a cross-cutting issue, and we will use existing networks of Institute of Alcohol Studies and PHE to disseminate results to parliamentarians and policy officials, and to contribute to upcoming government consultations.

We will hold a symposium for policymakers, and release a summary briefing with policy recommendations, with input from PHE and PPI representatives. An IAS report will be distributed to the media, featured in the Alcohol Alert newsletter, and on social media. A peer-reviewed journal article will also be submitted.