Statistics on Public Health, England 2021

This section presents information on the number of hospital admissions for diseases, injuries and conditions that can be attributed to alcohol consumption. The data in this section come from the Office for Health Improvement and Disparities Local Alcohol Profiles for England, which use data from NHS England’s Hospital Episode Statistics.

Estimates of the number of alcohol-related hospital admissions have been calculated by applying alcohol-attributable fractions (AAFs) to Hospital Episode Statistics data. An AAF is the proportion of a condition assessed to have been caused by alcohol.  See Appendix B.1 for more details.

Two measures for alcohol-related hospital admissions have been used:

• Narrow measure – where the main reason for admission to hospital was attributable to alcohol. 
• Broad measure – where the primary reason for hospital admission or a secondary diagnosis was linked to alcohol.

The narrow measure estimates the number of hospital admissions which are primarily due to alcohol consumption and provides the best indication of trends in alcohol-related hospital admissions. These are admissions where an alcohol-related disease, injury or condition was the primary reason for a hospital admission or an alcohol-related external cause was recorded in a secondary diagnosis field.

The broad measure gives an indication of the full impact of alcohol on hospital admissions and the burden placed on the NHS.

Note: these indicators use a new set of AAFs, and so differ from previously published data. Time series comparisons are based on the new AAFs but data is only available from 2016/17.

Admissions by year

In 2019/20 there were 280 thousand estimated admissions where the main reason for admission to hospital was attributable to alcohol (narrow measure).

This is 2% higher than 2018/19 and 8% higher than 2016/17.

This represents 1.6% of all hospital admissions which is unchanged since 2016/17.

There were almost 980 thousand estimated admissions where the primary reason for hospital admission or a secondary diagnosis was linked to alcohol, which is 4% higher than 2018/19 (broad measure). Changes over a longer time period will partly reflect improvements in recording of secondary diagnoses.

This represents 5.7% of all hospital admissions. 

Admissions by age

24% of patients were aged between 65 and 74.

This part presents information on the number of hospital admissions that are attributable to smoking. The commentary covers the latest available data (2019/20 for hospital admissions) but the tables provide data from the previous year since this has not been published before.

Figures presented relate to people aged 35 and over because this age group is most likely to be affected by smoking-related ill health.

• Hospital admissions data is taken from the latest available Hospital Episode Statistics (HES) and is based on the primary diagnosis.

Links to local authority level data data and self-reported health by smoking status are also provided.

Please note that the charts are based on rounded data. Unrounded data are available in the corresponding data tables.

Hospital admissions estimated to be attributable to smoking, by year

In 2019/20 there were estimated to be 506,100 hospital admissions attributable to smoking.

This is similar to 2018/19 when it was 504,200 and higher than 2009/10 when it was 461,700 (an increase of 10%).

In 2019/20 this represented 4% of all hospital admissions (down from 5% in 2009/10), and 25% of hospital admissions for conditions that can be caused by smoking (down from 31% in 2009/10).

Hospital admissions estimated to be attributable to smoking, by cause

21% of all admissions for respiratory diseases, 14% of all admissions for circulatory diseases, and 9% of all admissions for cancers, were estimated to be attributable to smoking.

47% of admissions for cancers that can be caused by smoking, and 38% of admissions for respiratory diseases that can be caused by smoking, were estimated to be attributable to smoking.

Hospital admissions estimated to be attributable to smoking by region and local authority per 100,000 population are provided in Public Health England Fingertips Tool Local Tobacco Control Profiles.

Adult smoking habits in the UK Statistical bulletins provide data on self-reported health by smoking status.

Hospital admissions: Tables S.1.1 and S.1.2, Statistics on Smoking, England, 2020

This part focuses on hospital admissions (inpatient settings only) related to being obese. Data is taken from NHS England's Hospital Episode Statistics (HES) database which contains details of all admissions at NHS hospitals in England.

The association between obesity and increased risk of many serious diseases and mortality is well documented and has led to the National Institute for Health and Clinical Excellence (NICE) developing guidelines on identifying and treating obesity.

Four measures are presented for the number of obesity-related hospital admissions:

1. NHS hospital finished admission episodes (FAEs) with a primary diagnosis of obesity – referred to as admissions directly attributable to obesity. A large proportion of these admissions involve a bariatric surgery procedure (see Tables O.2.1 to O.2.5 in the excel datasets).
2. NHS hospital finished admission episodes with a primary or secondary diagnosis of obesity - referred to as admissions where obesity was a factor. A secondary diagnosis of obesity does not necessarily indicate obesity as a contributing factor for the admission, but may instead indicate that obesity is a factor relevant to a patient’s episode of care. (see Tables O.3.1 to O.3.6 in the excel datasets).
3. NHS hospital finished consultant episodes (FCEs) with a primary diagnosis of obesity, and a primary or secondary procedure for bariatric surgery - referred to as obesity-related bariatric surgery.  (see Tables O.4.1 to O.4.5 in the excel datasets).
4. NHS hospital finished consultant episodes (FCEs) with a primary diagnosis of obesity, and a primary or secondary procedure for bariatric surgery, but excluding maintenance, revisional, and removal procedures - referred to as obesity-related primary bariatric surgery. In this measure most patients would only be counted once (for their initial procedure).  Though not commented on within the report, it is available in data table O.4.1.

An FAE is the first period of inpatient care under one consultant within one provider.  An FCE is a continuous period of admitted patient care under one consultant within one healthcare provider. Please note that admissions do not represent the number of in-patients, as a person may have more than one admission within the year.

Bariatric surgery encompasses a group of procedures that can be performed to facilitate weight loss, although these procedures can also be performed for other conditions. It includes stomach stapling, gastric bypasses and sleeve gastrectomy. In general, such surgery is used in the treatment of obesity for people with a BMI above 40, or those with a BMI between 35 and 40 who have health problems such as type 2 diabetes or heart disease. 

Admissions directly attributable to obesity, by year and sex

Note that many of these admissions will be for bariatric surgery procedures, and changes over time may in part reflect changes in uptake of these procedures, and so are not necessarily prevalence driven.

In 2019/20 there were 10,780 hospital admissions with a primary diagnosis of obesity, a decrease of 3% on 2018/19 (11,117 admissions). 

3 in every 4 patients were female (75%) and this is similar over time.

Admissions where obesity was a factor, by year and sex

In 2019/20 there were just over 1 million (1,022 thousand) hospital admissions where obesity was recorded as the primary or a secondary diagnosis. This is an increase of 17% on 2018/19, when there were 876 thousand admissions. 

Some (though not all) of this increase may be due to hospitals being more likely to record obesity as a secondary diagnosis than they were previously. See the Data Quality Statement (coherence and comparability) for more information.

Around 2 in every 3 patients were female (64%) and this is similar over time.

Admissions by age group

For admissions directly attributable to obesity, the number increases to middle age, peaking at 45 to 54, before declining in older age groups.

69% of patients were aged between 35 and 64 and this is similar over time.

Admissions where obesity was a factor by primary diagnosis (top ten diagnoses)

Of those admissions where obesity was a factor, but it was not the primary diagnosis (main reason for the admission), the most common diagnoses related to maternity issues and knee joint issues (arthrosis of the knee). Others in the top ten diagnosis types were the formation of gallstones (Cholelithiasis), heart disease and hip issues (arthrosis of the hip). 

Note that overall there were a large number of different primary diagnoses recorded for admissions where obesity was a factor, and collectively the top ten diagnosis types accounted for less than 20% of all these admissions (201 thousand of 1,022 thousand).

Admissions by deprivation level (rate per 100,000 population)

Admissions were mapped to Index of Multiple Deprivation deciles and rates age standardised using the European standard population.

Rates for both admissions directly attributable to obesity, and for admissions where obesity was a factor increase with the level of deprivation. 

Admissions directly attributable to obesity were over three times more likely in the most deprived areas (31 per 100,000 population), compared to the least deprived areas (9 per 100,000 population).

Admissions where obesity was a factor were over twice as likely in the most deprived areas (2,778 per 100,000 population), compared to the least deprived areas (1,139 per 100,000 population).

Admissions where obesity was a factor by Local Authority (rate per 100,000 population)

Admission rates have been age standardised and rounded to the nearest whole number.

Admission rates ranged from 626 to 4,081 per 100,000 population, with the highest admission rate over 6 times greater than the lowest rate. The national rate was 1,869 per 100,000 population.

Southwark, Wirral, Southampton, Lambeth, Newham all recorded admission rates of over 3,500 per 100,000 population.

West Berkshire, Wokingham and Redcar and Cleveland all recorded admission rates below 700 per 100,000 population.

Admissions rate per 100,000 population by Local Authority where obesity was a factor

Local Authority rates for admissions directly attributable to obesity are available in table O.2.3.

Additionally an interactive tool based on the Local Authority data, including time series, is available via the button below:

Obesity-related bariatric surgery admissions, by year and sex

In 2019/20 there were 6,740 hospital admissions with a primary diagnosis of obesity and a main or secondary procedure of bariatric surgery. This is a decrease of 4% on 2018/19 (7,011). 

80% of admissions were for females and this is similar over time.

Obesity-related bariatric surgery admissions, by age group

A third of patients (33%) were aged between 45 and 54 and this is similar over time.

Obesity-related bariatric surgery admissions by deprivation level (rate per 100,000 population)

As with the other measures, obesity-related bariatric surgery admission rates increase with the level of deprivation. 

Admissions for obesity-related bariatric surgery were over 3 times more likely in the most deprived areas (19 per 100,000 population), compared to the least deprived areas (6 per 100,000 population).

Obesity-related bariatric surgery admissions, by Local Authority (rate per 100,000 population)

Admission rates have been age-standardised and rounded to the nearest whole number.

Admission rates ranged from 0 to 38 per 100,000 population. The national rate was 12 per 100,000 population.

South Tyneside (38 per 100,000 population), Sunderland (38 per 100,000 population) and Southwark (37 per 100,000 population) recorded the highest admission rates.

City of London and Isles of Scilly both recorded zero rates.

Note that variation in rates across Local Authorities may reflect differences in provision and uptake of bariatric surgery procedures, and not necessarily differences in obesity prevalence.

Obesity-related bariatric surgery admissions rate per 100,000 population by Local Authority

For more data relating to this section:

Data Tables: Statistics on Obesity, Physical Activity and Diet, England, 2021

Other related information is available in the National Obesity Audit publications.

This part presents information on the number of hospital admissions (inpatient settings only) related to drug misuse.

Three measures for the number of drug-related hospital admissions have been calculated using Hospital Episode Statistics (HES) data:

• Measure 1 – hospital admissions with a primary diagnosis of drug-related mental and behavioural disorders – referred to as admissions for drug-related mental and behavioural disorders. 
• Measure 2 – hospital admissions with a primary diagnosis of poisoning by drugs, that are listed as controlled under the Misuse of Drugs Act 1971 (includes both intentional and unintentional poisoning) – referred to as admissions for poisoning by drug misuse.

For measures 1 and 2, a drug-related mental and behavioural disorder, or poisoning by drug misuse were the main reason for the admission (primary diagnosis).

• Measure 3 – hospital admissions with a primary or secondary diagnosis of drug-related mental and behavioural disorders – referred to as admissions where drug-related mental and behavioural disorders were a factor.

Measure 3 is a broader indicator of drug-related admissions. This is because a secondary diagnosis does not necessarily mean that a drug-related mental and behavioural disorder was a contributing factor for the admission, but may instead have just been relevant to a patient’s episode of care. The data quality of secondary procedures has increased over time so increases in admissions, compared to 10 years ago, may partly reflect an improvement in data quality as well as an increase in activity. See the data quality statement for more information.

More detail on the methods used to calculate these measures is provided in Appendix B.1.

The latest data is for 2019/20

COVID-19 and the production of statistics:  Due to the coronavirus illness (COVID-19) disruption, it would seem that there is some effect on the quality and coverage of some of our statistics in relation to the 2020/21 period. It is known that many hospitals are reporting zero or significantly less activity across one or more datasets for March 2020 onwards. The HES data in this publication relates to 2019/20, therefore, the end of the reporting period for this publication includes some of the pandemic period but this is estimated to have a negligible impact on the data.

Hospital admissions for drug-related mental and behavioural disorders, and for poisoning by drug misuse

This section covers analysis of measures 1 and 2 (see above), which is those admissions where drug misuse was the primary reason for the admission (whether as a result of drug-related mental and behavioural disorders or poisoning).

Admissions by year

In 2019/20 there were 7,027 admissions for drug-related mental and behavioural disorders, a 5% decrease on 2018/19 (7,376), and 18% less than the highest recorded number of admissions of the time series, in 2015/16 (8,621). This was preceded by a period of mostly increases; the current level still being 21% higher than 2009/10 (5,809). The number of admissions for 2019/20 represents a rate of 12.5 per 100,000 population.

There were 16,994 admissions for poisoning by drug misuse, a 6% decrease on 2018/19 (18,053), but 9% higher than in 2012/13 (15,580). This measure was subject to a methodological change in 2012/13 and so data is not comparable before then (see the data quality statement for more information). The number of admissions for 2019/20 represents a rate of 30.5 per 100,000 population.

Time series data is available as a rate per 100,000 population in the accompanying data tables, and shows similar trends.

Admissions by sex

More men than women were admitted to hospital for drug-related mental and behavioural disorders (73% male). However, there were similar proportions of men and women admitted to hospital due to poisoning by drug misuse.

Admissions by age

Admissions for drug-related mental and behavioural disorders, and for poisoning by drug misuse, showed similar age profiles. Levels were highest for younger people (apart from those under 16), peaking between ages 25 and 34. Admissions for drug-related mental and behavioural disorders are lowest for those aged under 16 and over 64.

Although admissions amongst people aged 45 and over are lower (see previous charts), numbers have increased more over time for this age group compared to those aged under 45.

Admissions for drug-related mental and behavioural disorders increased by 75% in those aged 45 and over since 2009/10 (from 744 to 1,300), compared with a 13% increase for those aged under 45 (5,048 to 5,725).

Admissions for poisoning by drug misuse increased by 30% in those aged 45 and over since 2012/13 (from 4,428 to 5,777), compared with a 1% increase for those aged under 45 (11,152 to 11,210).

Admission rates by deprivation level (per 100,000 population) 

Admissions were mapped to Index of Multiple Deprivation deciles and rates age standardised using the European standard population (see Appendix B.1 for more information).

Admission rates for both drug-related mental and behavioural disorders, and for poisoning by drug misuse increase with the level of deprivation. 

Admissions for drug-related mental and behavioural disorders were around 5 times more likely in the most deprived areas (27 per 100,000 population), compared to the least deprived areas (5 per 100,000 population).

Admissions for poisoning by drug misuse were also around 5 times more likely in the most deprived areas (69 per 100,000 population), compared to the least deprived areas (13 per 100,000 population).

Admission rates by Local Authority (per 100,000 population)

Admission rates have been age standardised using the European standard population (see Appendix B.1 for more information).

Drug-related mental and behavioural disorders

Kingston upon Hull had the highest admission rate with 49 per 100,000 population, followed by Liverpool (48), Stoke-on-Trent (44) and St Helens (43).

13 LAs recorded rates of less than 5 per 100,000 population (shown in descending order): Lincolnshire, Barnet, Enfield, York, Dudley, Sandwell, Walsall, North East Lincolnshire, Rutland, Wolverhampton, Merton, Windsor and Maidenhead and the Isles of Scilly.

Poisoning by drug misuse

Middlesbrough had the highest admission rate with 106 per 100,000 population, followed by the Wirral (80), St Helens (77) and Knowsley (76).

9 LAs recorded rates of less than 10 per 100,000 population (shown in descending order): Rutland, Enfield, Waltham Forest, Barking and Dagenham, Brent, Newham, Redbridge, City of London and the Isles of Scilly. 

An additional visualisation of this data, including time series, is available at the link below.

This section covers analysis of measure 3 (see top section), which is those admissions where a drug-related mental and behavioural disorder was the primary or a secondary diagnosis. A secondary diagnosis does not necessarily mean that a drug-related mental and behavioural disorder was a contributing factor for the admission, but may instead just have been relevant to a patient’s episode of care. 

Admissions by year and sex

There were 99,782 admissions with a primary or secondary diagnosis of drug-related mental and behavioural disorders. This is an increase of 3% on 2018/19, when there were 96,705 admissions. 

The number of admissions for 2019/20 represents a rate of 180.5 per 100,000 population.

A breakdown of these admissions by primary diagnosis can be seen in table D.3.2.

More men than women were admitted. In total, 69% of the patients were male.

Admissions by age

Admissions were highest for people aged between 25 and 44, with those age groups representing 53% of all patients. Admissions are lowest in those aged under 16 and over 75.

Admission rates by deprivation level (per 100,000 population) 

As with the other measures, admission rates increase with the level of deprivation. 

Admissions where drug-related mental and behavioural disorders were a factor were over 8 times more likely in the most deprived areas (470 per 100,000 population), compared to the least deprived areas (55 per 100,000 population).

Admission rates by Local Authority (per 100,000 population)

Hartlepool had the highest admission rate with 606 per 100,000 population, followed by Blackpool (569), and Liverpool (485).

The lowest rates were in Bracknell Forest (77), Windsor and Maidenhead (66), and Rutland (65). 

An additional visualisation of this data, including time series, is available at the link below.

Definitions vary between countries. See source publications at the links below for further details.

Scotland

Public Health Scotland publishes data on the number of drug-related hospital stays, the number and characteristics of patients admitted to hospital, the substances involved and the geographical variations within Scotland.

Drug-related hospital statistics

Wales

Public Health Wales publish an annual statistical report on alcohol and drug use from health, social care, education and criminal justice services datasets in Wales. This includes data on hospital admissions involving use of illicit drugs. The latest report is available here:

Data mining Wales: The annual profile for substance misuse 2018 - 19

Northern Ireland

Northern Ireland's Department of Health provides episode based acute hospital inpatient and day case activity data obtained from the hospital inpatient system (HIS), which is a patient level administrative data source:

Episode based activity