Each hospital admission is assigned a main diagnosis (cause) of admission, and each death is assigned an underlying cause of death. Secondary diagnosis codes and causes can also be given if there are other influential medical factors or causes for the admission or death. The system used to code these diagnoses and causes is the International Classification of Diseases. The latest version used for hospital and mortality records is version 10 which was introduced in 2001. This not only consists of codes for all the known medical conditions and diseases, but also other reasons, causes or factors for the admission or death. These other codes include codes for routine hospital care, such as those related to screening, diagnosis or maternity, and other external factors such as traffic accidents, injuries, falls, poisoning, suicide, etc. It is possible that not all relevant secondary diagnoses codes will be coded, and included on the admission or mortality data as it will depend on what doctors write and record in their medical notes or on the death certificate.
Each of the ICD codes have been assigned an ‘alcohol attributable fraction’ (AAF) which has been determined through research and analysis of hospital admission and death data nationally and relates to the percentage of admissions or deaths within that age group and for that gender that are caused by alcohol for that specific ICD 10 code (i.e. each medical condition, disease or secondary cause). Admissions and deaths which are classified as alcohol-related use these AAF values to estimate the number of hospital admissions and deaths which are related to alcohol.
Alcohol-specific admissions and deaths relate to those medical conditions that are wholly attributable to alcohol (and have an AAF value of 1).
Alcohol-specific admissions are any admissions that have a primary diagnosis or any of the secondary diagnoses that are medical conditions that are wholly attributable to alcohol. Alcohol-specific deaths are any deaths that have an underlying cause of death from a medical condition that is wholly attributable to alcohol, but also includes deaths with a secondary cause of death relating to poisoning (accidental, intentional or undetermined).
The following causes of death (with ICD 10 codes) have an AAF value of 1 denoting that they are specially due to alcohol or wholly attributable to alcohol.
- Alcohol-induced pseudo-Cushing’s syndrome (E24.4)
- Mental and behavioural disorders due to use of alcohol (F10)
- Degeneration of nervous system (G31.2)
- Alcoholic polyneuropathy (G62.1)
- Alcoholic myopathy (G72.1)
- Alcoholic cardiomyopathy (I42.6)
- Alcoholic gastritis (K29.2)
- Alcoholic liver disease (K70)
- Alcohol-induced acute pancreatitis (K85.2)
- Alcohol-induced chronic pancreatitis (K86.0)
- Fetal alcohol syndrome – dysmorphic (Q86.0)
- Excess alcohol blood levels (R78.0)
- Ethanol poisoning (T51.0)*
- Methanol poisoning (T51.1)*
- Toxic effect of alcohol, unspecified (T51.9)*
- Accidental poisoning by and exposure to alcohol (X45)
- Intentional self-poisoning by and exposure to alcohol (X65)
- Poisoning by and exposure to alcohol, undetermined intent (Y15)
- Evidence of alcohol involvement determined by blood alcohol level (Y90)*
- Evidence of alcohol involvement determined by level of intoxication (Y91)*
*Does not appear to be included in the measure relating deaths, but appears to be included for hospital admissions.
Also see Alcohol-attributable fractions for England: an update, published by Public Health England (now Office for Health Improvement & Disparities) in 2020.
Also see Alcohol Attributable Fractions, Alcohol Consumption – Definitions and Units, International Classification of Diseases and Smoking Attributable Fractions.
Also see Directly Standardised Rate.