Rosalind Blackwood

Ros is a Consultant in Public Health Medicine, with a focus on optimising efficiency and effectiveness in healthcare alongside health improvement. Recently, as clinical director for a digital-first medical technology company, she developed digital clinical decision aids and clinical risk prediction tools for some of the major causes of morbidity and mortality in the UK. Prior to that Ros was joint clinical director for the National Clinical Policy Team at NHS England’s Specialised Services, developing commissioning policies for rare diseases.

Ros is a post-doc at King’s College London, where she was awarded her PhD in 2019 having investigated people who were frequently admitted to hospital for alcohol related problems, assessing the scale of the issue nationally as well as the clinical impact on individuals, using routine hospital administrative data. She continues her research interest in alcohol related liver disease and its prevention.

Multiple hospital admissions for alcohol as an early indicator of future alcohol-related liver disease and premature mortality

Aims: To test whether people with frequent alcohol admissions experience higher rates of alcohol-related liver disease (ARLD) and early death, compared to other hospital users.

Methods: A sample of routine data consisting of 489,580 patients from a total of 7,654,944 adults aged >=18 years, treated in English hospitals between 1 April 2011 and 31 March 2016. Patients were categorised as having alcohol-related admissions if diagnoses included a wholly attributable alcohol diagnosis and frequent admissions if they had >3 hospital admissions during a single Hospital Episode Statistics (HES) year.

Death in hospital between 1 April 2011 and 31 March 2016 was the primary outcome measure and Kaplan Meier survival curves were calculated. Other outcomes included prevalence of ARLD (presence of one or more of ICD10 code K700, K701, K702, K703, K704, K709) across the entire five-year period; and incidence of ARLD and end-stage ARLD (presence of one or more of ICD10 code K703 or K704).

Findings: People admitted to hospital with frequent alcohol-related admissions have a lower probability of survival at five years across all ages than other patient groups. Excess mortality was highest for those with alcohol-related admissions (frequent and non-frequent) in the under 44-year-old age group.

Conclusions: People with frequent alcohol-related admissions have an exceptionally high risk both for the onset of ARLD and for death, with the risk being particularly elevated among younger patients. Without preventative strategies, these patients are very likely to need liver transplants as well as access to timely end-of-life care.