Alcohol-Related Brain Damage
University of South Wales
How many people have ARBD?
When you first heard about Alcohol-Related Brain Damage, one of the first questions that you may have might be how many people have ARBD? This is not a straightforward question to answer for a number of reasons. One of thes reasons is that there are a variety of conditios that will fall under the spectrum of ARBD, and there are also a number of difficulties associated with identifying and diagnosing the condition. This makes it harder to be able to calculate the exact number of people who have ARBD because there may be a number of people who have not yet been identified, or who may have received a diagnosis of something else, that is, they might be misdiagnosed.
This means that the estimations that we have at the moment are conservative and the true numbers are likely to be higher. The University of South Wales collaborated with the Pobl group to try and calculate the number of people with ARBD in Wales. This is the most recent and comprehensive analysis in Wales to date, and it suggests that around 34 individuals out of every 100,000 will have ARBD. Although this figure might seem relatively small, this means that ARBD prevalence in Wales almost four times that of Motor Neuron Disease.
Hospital Admissions for ARBD
Information collected from hospitals can be particularly helpful in understanding the prevalence rates of ARBD and have been used to examine prevalence trends. Analyses of hospital admissions related to ARBD over 10 years in South Wales showed that there was an average acute prevalence rate of 0.014%.
There was an average of 366 hospital admissions relating to ARBD each year in South Wales, which accounted for 279 individuals each year (with a number of patients being admitted on more than one occasion.) Over 10-years, there was an increase in ARBD-related hospital admissions of 20.4% and an increase in the number of patients of 24.3%.
The average length of hospital stay for this population was 28.8 days per individual which accounts for 10,567 hospital stay days relating to ARBD in South Wales.
The outcomes for those admitted to hospital with ARBD is also relatively poor with a mortality rate of 14.3%.
In England, admissions related to alcohol are reported to account for 7.2% of all hospital admissions between 2017/18. Mortality rate estimates suggest that those who are admitted to hospital at a higher age are more likely to have poorer outcomes than those admitted at a younger age. Alcohol consumption is also reported to be responsible for 1 in 20 deaths in Wales.
Data collected at hospital discharge in Scotland also suggests an upward trend in those diagnosed with ARBD, especially in men between the ages of 40-60. Males are also more likely to be admitted to hospital for ARBD, with the average age being 56 for men and 50 for females in Glasgow.
Prevalence Elsewhere
In comparing the number of people who have ARBD in Wales and other countries, these figures are likely to reflect the number of people who consume large quantities of alcohol across various regions. For example, Scotland is known to have a substantial number of people who drink an excessive amount of alcohol as well as a high number of alcohol-related mortalities. This is reflected in research that suggests that there is also a high prevalence if ARBD with estimated suggesting a prevalence rate of up to 0.14%, which is higher than that found in Wales (0.034%).
Within communities, those who often drink large amounts of alcohol, such as some homeless populations are also reported to have higher rates of ARBD. Evidence from the University of South Wales as well as a number of other studies suggests that the number of people who present with ARBD is increasing, both in the UK and Ireland. Issues with calculating the number of people with ARBD are apparent across these geographical locations meaning that estimations of those with ARBD will usually be lower than the actual number of people with the condition across countries and across various groups of individuals.
Post-Mortem Studies
Some older studies have used post-mortem methods to look at the brains of people who have died to determine how many people show evidence of alcohol-related brain damage. In a study of the brains from the general population, it was found that 1.5% of these brains showed visible damage to the brains tissue. Another study only looked at the brains of people who were known to be heavy-drinkers but looked at samples from across the world. This study reported that around 30% of these brains showed evidence of ARBD.
One further study investigated damage to the brain in a post-mortem study and of the brains that were found to have evidence of Wernicke-Korsakoff’s Syndrome, only 16% of these individuals have been identified and diagnosed during their lifetime. This again suggests that many people may have damage to their brains from alcohol that are not yet identified.
This suggests that females may be more susceptible to the effects of alcohol misuse, as if they have the condition, they seem to present with difficulties associated with ARBD sooner than males. Some other patterns have been reported, such as that those who live in areas that are classified as having a high rate of social deprivation are also more likely to show higher rates of ARBD. As might be expected, the more vulnerable groups of society tent to be disproportionally affected by ARBD such as the homeless population.
One thing that is worth bearing in mind, is that although this typical profile of males in their late 50s may be helpful in identifying some people with ARBD, these statistics may conceal some others who also have ARBD. This is important to consider as the number of females with the condition seems to be increasing and the age at which people are found to have ARBD is decreasing, meaning that individuals are presenting to services who are younger and younger.
Who is at risk of ARBD?
It might also be helpful to consider who might have ARBD or be at risk of developing the condition. In a study conducted by the University of South Wales, the ages of people with ARBD were compared. The highest number of individuals as found in the 45-64 age bracket by far, although there were a considerable amount of people younger and older than this.
The majority of those with a diagnosis or suspected diagnosis of ARBD were more likely to be male (71.8%) and the average age of those who were confirmed as having ARBD was 58 years old. There were however a number of individuals younger than this, with 23 cases being reported where the person was under the age of 35. One case was even documented at the age of 20. Although females were less likely to have the condition, the age of females with the condition was significantly younger than men with the condition.
