Research and analysis

Monitoring alcohol consumption and harm during the COVID-19 pandemic: summary

Published 15 July 2021

Applies to England

Background

This report collates data on alcohol consumption and alcohol-related harm in England throughout the coronavirus (COVID-19) pandemic and compares it to data from previous years.

The report’s aim is to understand how indicators of alcohol consumption and harm have changed while the social and physical restrictions to prevent and control COVID-19 were in place. These restrictions led to changes in the availability of alcohol, most notably the approximately 31-week closure of on-trade premises, such as pubs and restaurants, during national lockdowns.

Changes to alcohol consumption in 2020

The total volume of duty-paid alcohol for the year of the pandemic (2020 to 2021) was 1.2% less than the year before the pandemic (2019 to 2020). This is despite the closure of on-trade premises during national lockdowns.

In 2020 to 2021, duty-paid wine and spirits increased compared to 2019 to 2020 (+8.9% and +7.3% respectively), while cider and beer decreased (-16.7% and -14.0% respectively). The diverging trends likely relate to the fact that beer and cider are more often bought in on-trade settings, so are probably more affected by on-trade closures.

Data from a consumer purchasing panel that measures off-trade volume sales of alcohol shows that between 2019 and 2020 (before and during the pandemic), volume sales increased by 25.0%. This increase was consistent and sustained for most of 2020. We saw increases for all product types, with the largest relative increase for beer (+31.2%), followed by spirits (+26.2%), wine (+19.5%), and cider (+17.6%). It’s worth noting that cider and beer saw the largest relative decreases when looking at the trends in duty-paid volume of alcohol.

To understand whether consumers who typically buy different volumes of alcohol showed different trends, we selected a subsample of buyers with continuous data reporting. We then split these buyers into 5 equal sized groups (quintiles) based on the volume of alcohol they bought weekly in the 2 years before the first national lockdown.

For this subsample, between 2019 to 2020 and 2020 to 2021 total volume off-trade sales increased by 24.4%. In absolute terms, the heaviest buying quintile increased their purchasing by 5.3 million litres of alcohol (+14.3%). Of the 12,607,408 extra litres of alcohol bought in 2020 to 2021 compared to 2019 to 2020, the heaviest buying quintile accounted for 42% of the total increase. This proportion increased to 68.3% of the total increase when including the top 2 heaviest buying quintiles.

Taken together, all survey data measuring self-reported alcohol consumption suggests a polarisation in drinking. Most respondents reported drinking the same volume and the same frequency as they did before the pandemic. Roughly similar proportions of respondents reported drinking more or more frequently and drinking less or less frequently. Where surveys measured a respondent’s drinking before the pandemic, they suggest that people who reported drinking more during the pandemic than before tended to be heavier drinkers.

Generally, the surveys and polls were low quality and reporting of methods varied. Higher quality repeated cross-sectional surveys gave a clearer picture. These surveys suggest that respondents were more likely to report increasing their alcohol consumption during the pandemic compared to previous years. For example, between March 2020 and March 2021, there was a 58.6% increase in the proportion of respondents drinking at increasing risk and higher risk levels. Importantly, this data shows a step-change around the time the pandemic began, where the prevalence of increasing risk and higher risk drinking increased and then continued to be higher than previous years throughout the pandemic year.

Changes to alcohol-specific morbidity and mortality in 2020

In 2020 (during the pandemic), rates of unplanned admissions to hospital for alcohol specific causes decreased by 3.2% compared to 2019 (before the pandemic). This is likely related to reduced admissions for mental and behavioural disorders due to alcohol use. Unplanned admissions for alcoholic liver disease were the only alcohol specific unplanned admissions to increase between 2019 and 2020. This increase was 13.5%, and from June 2020 onwards, there were significant and sustained increases in the rate of unplanned admissions for alcoholic liver disease.

We saw rapid decreases in the rate of alcohol specific admissions that coincided with the start of the pandemic (around February 2020). However, this finding is not unique to alcohol. All unplanned admissions, irrespective of their cause, sharply decreased as the pandemic took hold. They also remained significantly lower than baseline (a weighted average of 2018 and 2019) throughout 2020 and 2021. This ‘lockdown effect’ likely relates to psychological factors where people reported avoiding hospitals to ease pressure on the NHS. It is also likely that people thought hospitals were high-risk settings for catching COVID-19, and were also concerned about leaving the house.

In 2020, there was a 20.0% increase in total alcohol specific deaths compared to 2019. We also saw significantly higher rates from May 2020 onwards (33.0% of deaths occurred in the most deprived group). Deaths from mental and behavioural disorders due to alcohol increased by 10.8% (compared to a 1.1% increase between 2018 and 2019), and deaths from alcohol poisoning increased by 15.4% (compared to a decrease of 4.5% between 2018 and 2019).

The upward trend in total alcohol specific deaths was brought about by increases in deaths from alcoholic liver disease. Alcoholic liver deaths accounted for 80.3% of total alcohol specific deaths in 2020 and saw a 20.8% increase between 2019 and 2020. From July 2020 onwards, rates of alcoholic liver disease deaths were significantly and consistently higher than baseline. Data from previous years show a rapid acceleration in deaths from alcoholic liver disease during the year of the pandemic, beyond that of the pre-existing upward trend. For example, the increase in alcoholic liver deaths between 2018 and 2019 was 2.9%. December 2020 rates of alcoholic liver disease deaths were 58.1% higher than the corresponding baseline month (11.7 per 100,000 population compared to 7.4) which was the greatest proportional difference across 2020 and 2021 data compared to monthly baselines.

Although alcohol related cirrhosis can take a decade or more to develop, most deaths occur as a result of acute-on-chronic liver failure due to recent alcohol intake, which is strongly linked to heavy drinking. Liver mortality rates responds rapidly to changes in population level alcohol consumption and particularly to changes in drinking patterns of heavy drinkers, as we have seen during this pandemic. Liver mortality rates in England have increased 43% between 2001 and 2019, to the extent that liver disease is now the second leading disease causing premature death among people of working age.

Conclusion

We will continue to monitor alcohol consumption and harm to investigate changes and develop appropriate policy and intervention responses.

Tackling alcohol consumption and harm must be an essential part of the UK government’s COVID-19 recovery plan, given that tackling geographic health disparities are part of the government’s Build Back Better plans. Alcohol harm is a major risk factor driving these differences.

Long-term, sustained action to prevent and reduce liver disease remains a priority for public health, given the stark trends in significantly higher alcoholic liver deaths, likely because of increased consumption among an already at-risk group of heavy drinkers.

Before the pandemic, there were already increased alcohol-related hospital admissions and deaths. The pandemic seems to have accelerated these trends.