Alcohol Consumption
Metadata
| Name | Alcohol Consumption |
| Type | Lifestyle Risk Factor |
| Group | Lifestyle Risk Factor |
| Data Sources |
|
| Clinical Terminologies |
Read Version 2 |
| Codelists | |
| Valid Event Data Range | 01/01/1999 - 01/07/2016 |
| Sex |
Female/Male |
| Authors | Bell S, Daskalopoulou M, Rapsomaniki E, George J, Britton A, Bobak M, Casas JP, Dale CE, Denaxas S, Shah AD, Hemingway H |
| Agreement Date | 23 Nov 2012 |
| Version (UUID) | Revision 1 (7aXDiYMtSR6aYEkZKPBdvm) |
Primary Care
In the Clinical Practice Research Datalink (CPRD, primary care data) we extracted information on alcohol consumption based on:
- Clinician-recorded alcohol consumption information
- Stuctured data elements related to daily/weekly alcohol unit consumption
- Evidence of alcohol abuse
- Evidence of alcohol-related harm
Alcohol consumption information
| Read code | Read term | CALIBER category |
|---|---|---|
| 1361 | Teetotaller | Non drinker |
| 1361.11 | Non drinker alcohol | Non drinker |
| 1361.12 | Non-drinker alcohol | Non drinker |
| 136M.00 | Current non drinker | Non drinker |
| 1367 | Stopped drinking alcohol | Ex drinker |
| 136A.00 | Ex-trivial drinker (<1u/day) | Ex drinker |
| 136B.00 | Ex-light drinker - (1-2u/day) | Ex drinker |
| 136C.00 | Ex-moderate drinker - (3-6u/d) | Ex drinker |
| 136D.00 | Ex-heavy drinker - (7-9u/day) | Ex drinker |
| 136E.00 | Ex-very heavy drinker-(>9u/d) | Ex drinker |
| 1362.11 | Drinks rarely | Occasional drinker (less than once per week) |
| 1362.12 | Drinks occasionally | Occasional drinker (less than once per week) |
| 136F.00 | Spirit drinker | Current drinker |
| 136G.00 | Beer drinker | Current drinker |
| 136H.00 | Drinks beer and spirits | Current drinker |
| 136I.00 | Drinks wine | Current drinker |
| 136J.00 | Social drinker | Current drinker |
| 136L.00 | Alcohol intake within recommended sensible limits | Current drinker |
| 136N.00 | Light drinker | Current drinker |
| 136O.00 | Moderate drinker | Current drinker |
| 1D19.00 | Pain in lymph nodes after alcohol consumption | Current drinker |
| 2577 | O/E - breath - alcohol smell | Current drinker |
| 2577.11 | O/E - alcoholic breath | Current drinker |
| E250.11 | Drunkenness NOS | Current drinker |
| E250.12 | Hangover (alcohol) | Current drinker |
| E250.13 | Inebriety NOS | Current drinker |
| E250.14 | Intoxication - alcohol | Current drinker |
| R103.00 | [D]Alcohol blood level excessive | Current drinker |
| U81..00 | [X]Evid of alcohol involv determind by level of intoxication | Current drinker |
| 136K.00 | Alcohol intake above recommended sensible limits | Excess drinker |
| 136P.00 | Heavy drinker | Excess drinker |
| 136Q.00 | Very heavy drinker | Excess drinker |
| 136S.00 | Hazardous alcohol use | Excess drinker |
| 136T.00 | Harmful alcohol use | Excess drinker |
| 136W.00 | Alcohol misuse | Excess drinker |
| 13ZY.00 | Disqualified from driving due to excess alcohol | Excess drinker |
| E23..12 | Alcohol problem drinking | Excess drinker |
| E250.00 | Nondependent alcohol abuse | Excess drinker |
| E250000 | Nondependent alcohol abuse, unspecified | Excess drinker |
| E250100 | Nondependent alcohol abuse, continuous | Excess drinker |
| E250300 | Nondependent alcohol abuse in remission | Excess drinker |
| E250z00 | Nondependent alcohol abuse NOS | Excess drinker |
| ZV11311 | [V]Problems related to lifestyle alcohol use | Excess drinker |
| 136R.00 | Binge drinker | Binge drinker |
| E250200 | Nondependent alcohol abuse, episodic | Binge drinker |
| 136..00 | Alcohol consumption | Drinker status not specified |
| 1368 | Alcohol consumption unknown | Drinker status not specified |
| 136V.00 | Alcohol units per week | Drinker status not specified |
| 136X.00 | Alcohol units consumed on heaviest drinking day | Drinker status not specified |
| 136Z.00 | Alcohol consumption NOS | Drinker status not specified |
| 9k19.00 | Alcohol assesment declined - enhanced services admin | Drinker status not specified |
| 9k19.11 | Alcohol assessment declined | Drinker status not specified |
| Z786200 | Drinking practice | Drinker status not specified |
| ZV4KC00 | [V] Alcohol use | Drinker status not specified |
Daily/weekly alcohol intake
We extracted alcohol unit intake information using the structured data part (entity type 5) of the additional table (units recorded in data2) field. We additionally extract information on intake through clinician-recorded classifications using Read terms (see below).
| Read code | Read term | CALIBER category |
|---|---|---|
| 1362 | Trivial drinker - <1u/day | Less than 1 unit/day |
| 1363 | Light drinker - 1-2u/day | 1-2 units/day |
| 1364 | Moderate drinker - 3-6u/day | 3-6 units/day |
| 1365 | Heavy drinker - 7-9u/day | 7-9 units/day |
| 1366 | Very heavy drinker - >9u/day | More than 9 units/day |
Alcohol abuse
| Read code | Read term | CALIBER category |
|---|---|---|
| C150500 | Alcohol-induced pseudo-Cushing's syndrome | Endocrine system |
| 1B1c.00 | Alcohol induced hallucinations | Mental Health |
| E01..00 | Alcoholic psychoses | Mental Health |
| E011.00 | Alcohol amnestic syndrome | Mental Health |
| E011000 | Korsakov's alcoholic psychosis | Mental Health |
| E011100 | Korsakov's alcoholic psychosis with peripheral neuritis | Mental Health |
| E011200 | Wernicke-Korsakov syndrome | Mental Health |
| E011z00 | Alcohol amnestic syndrome NOS | Mental Health |
| E012.00 | Other alcoholic dementia | Mental Health |
| E012.11 | Alcoholic dementia NOS | Mental Health |
| E015.00 | Alcoholic paranoia | Mental Health |
| E01y.00 | Other alcoholic psychosis | Mental Health |
| E01yz00 | Other alcoholic psychosis NOS | Mental Health |
| E01z.00 | Alcoholic psychosis NOS | Mental Health |
| Eu10.00 | [X]Mental and behavioural disorders due to use of alcohol | Mental Health |
| Eu10000 | [X]Mental & behav dis due to use alcohol: acute intoxication | Mental Health |
| Eu10100 | [X]Mental and behav dis due to use of alcohol: harmful use | Mental Health |
| Eu10500 | [X]Mental & behav dis due to use alcohol: psychotic disorder | Mental Health |
| Eu10511 | [X]Alcoholic hallucinosis | Mental Health |
| Eu10512 | [X]Alcoholic jealousy | Mental Health |
| Eu10513 | [X]Alcoholic paranoia | Mental Health |
| Eu10514 | [X]Alcoholic psychosis NOS | Mental Health |
| Eu10600 | [X]Mental and behav dis due to use alcohol: amnesic syndrome | Mental Health |
| Eu10611 | [X]Korsakov's psychosis, alcohol induced | Mental Health |
| Eu10700 | [X]Men & behav dis due alcoh: resid & late-onset psychot dis | Mental Health |
| Eu10711 | [X]Alcoholic dementia NOS | Mental Health |
| Eu10y00 | [X]Men & behav dis due to use alcohol: oth men & behav dis | Mental Health |
| Eu10z00 | [X]Ment & behav dis due use alcohol: unsp ment & behav dis | Mental Health |
| E012000 | Chronic alcoholic brain syndrome | Nervous system |
| Eu10712 | [X]Chronic alcoholic brain syndrome | Nervous system |
| F11x000 | Cerebral degeneration due to alcoholism | Nervous system |
| F11x011 | Alcoholic encephalopathy | Nervous system |
| F144000 | Cerebellar ataxia due to alcoholism | Nervous system |
| F25B.00 | Alcohol-induced epilepsy | Nervous system |
| F375.00 | Alcoholic polyneuropathy | Nervous system |
| F394100 | Alcoholic myopathy | Circulatory system |
| G555.00 | Alcoholic cardiomyopathy | Circulatory system |
| G852300 | Oesophageal varices in alcoholic cirrhosis of the liver | Digestive system |
| J153.00 | Alcoholic gastritis | Digestive system |
| J610.00 | Alcoholic fatty liver | Digestive system |
| J611.00 | Acute alcoholic hepatitis | Digestive system |
| J612.00 | Alcoholic cirrhosis of liver | Digestive system |
| J612000 | Alcoholic fibrosis and sclerosis of liver | Digestive system |
| J613.00 | Alcoholic liver damage unspecified | Digestive system |
| J613000 | Alcoholic hepatic failure | Digestive system |
| J617.00 | Alcoholic hepatitis | Digestive system |
| J617000 | Chronic alcoholic hepatitis | Digestive system |
| J671000 | Alcohol-induced chronic pancreatitis | Digestive system |
Implementation
The most recent alcohol consumption record in the five years before entry into the study was used to classify participants drinking behaviour. In light of current debates on the U/J-shaped relationship observed between alcohol consumption and aggregated CVD outcomes10 five drinking categories were defined including: (1) non-drinkers (Read66 codes such as “tee-total” and “non-drinkers”), former drinkers (those with codes for “stopped drinking alcohol” and/or “ex-drinker”), occasional drinkers (those with codes for “drinks rarely” and/or “drinks occasionally”), current moderate drinkers (those who had a code for current alcohol consumer and an indicator of whether they drank within daily [32g or 24g of alcohol for men and women respectively] and/or weekly [168g of alcohol for men and 112g for women] recommended sensible drinking limits for the UK at the time of observation69) and current heavy drinkers (defined as those who exceeded daily and/or weekly sensible drinking limits). We also utilised data fields with information entered on daily and/or weekly amount of alcohol consumed to define participants as non-drinkers, moderate drinkers (drank within daily and/or weekly guidelines) and heavy drinkers. Weekly alcohol data was available as a continuous variable, so we were able to classify consumption using standard thresholds
Data on daily alcohol intake was entered using categories of: (1) < 1 UK unit (8 grams of ethanol), (2) 1-2 UK units, (3) 3-6 UK units, (4) 7-9 UK units, and (5) > 9 UK units [Read codes 1362.00-1366.00], for which we defined moderate drinking as anything >1 UK unit but less than 3 (women) or 7 (men) UK units. Unfortunately information on binge drinking was only available for a select minority of the cohort (~100 people) therefore a separate category for this drinking behaviour was not defined (but these patients were coded as heavy drinkers). We reclassified non-drinkers as former drinkers if they had any record of drinking recorded in their entire clinical record entered on CPRD prior to study entry (in cases whereby non-drinkers had no record of drinking before entering the study we assumed that they were not former drinkers). This resulted in 19,853 (out of 184,747; 10.7%) non-drinkers being recoded as former drinkers, a further 6,826 (3.7%) participants were reclassified through having a positive history of alcohol abuse.
Publications
Gho JMIH et al. An electronic health records cohort study on heart failure following myocardial infarction in England: incidence and predictors. BMJ Open. 2018 Mar 3;8(3):e018331. doi: 10.1136/bmjopen-2017-018331. PMID: 29502083 Steele AJ et al. Machine learning models in electronic health records can outperform conventional survival models for predicting patient mortality in coronary artery disease. PLoS One. 2018 Aug 31;13(8):e0202344. doi: 10.1371/journal.pone.0202344. eCollection 2018. PMID: 30169498 Archangelidi O et al. Clinically recorded heart rate and incidence of 12 coronary, cardiac, cerebrovascular and peripheral arterial diseases in 233,970 men and women: A linked electronic health record study. Eur J Prev Cardiol. 2018 Sep;25(14):1485-1495. doi: 10.1177/2047487318785228. Epub 2018 Jul 2. PMID: 29966429 Koudstaal S et al. Prognostic burden of heart failure recorded in primary care, acute hospital admissions, or both: a population-based linked electronic health record cohort study in 2.1 million people. Eur J Heart Fail. 2017 Sep;19(9):1119-1127. doi: 10.1002/ejhf.709. Epub 2016 Dec 23. PMID: 28008698 Chung SC et al. Time spent at blood pressure target and the risk of death and cardiovascular diseases. PLoS One. 2018 Sep 5;13(9):e0202359. doi: 10.1371/journal.pone.0202359. eCollection 2018. PMID: 30183734 Bell S et al. Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: population based cohort study using linked health records. BMJ. 2017 Mar 22;356:j909. PMID: 28331015 Pasea L et al. Personalising the decision for prolonged dual antiplatelet therapy: development, validation and potential impact of prognostic models for cardiovascular events and bleeding in myocardial infarction survivors. Eur Heart J. 2017 Apr 7;38(14):1048-1055. doi: 10.1093/eurheartj/ehw683. PMID: 28329300 Shah AD et al. Neutrophil Counts and Initial Presentation of 12 Cardiovascular Diseases: A CALIBER Cohort Study. J Am Coll Cardiol. 2017 Mar 7;69(9):1160-1169. doi: 10.1016/j.jacc.2016.12.022. PMID: 28254179 Asaria M et al. Using electronic health records to predict costs and outcomes in stable coronary artery disease. Heart. 2016 May 15;102(10):755-62. doi: 10.1136/heartjnl-2015-308850. Epub 2016 Feb 10. PMID: 26864674 Daskalopoulou M et al. Depression as a Risk Factor for the Initial Presentation of Twelve Cardiac, Cerebrovascular, and Peripheral Arterial Diseases: Data Linkage Study of 1.9 Million Women and Men. PLoS One. 2016 Apr 22;11(4):e0153838. doi: 10.1371/journal.pone.0153838. eCollection 2016. PMID: 27105076 Pujades-Rodriguez M et al. Associations between polymyalgia rheumatica and giant cell arteritis and 12 cardiovascular diseases. Heart. 2016 Mar;102(5):383-9. doi: 10.1136/heartjnl-2015-308514. Epub 2016 Jan 19. PMID: 26786818 Pujades-Rodriguez M et al. Rheumatoid Arthritis and Incidence of Twelve Initial Presentations of Cardiovascular Disease: A Population Record-Linkage Cohort Study in England. PLoS One. 2016 Mar 15;11(3):e0151245. doi: 10.1371/journal.pone.0151245. eCollection 2016. PMID: 26978266 Shah AD et al. Low eosinophil and low lymphocyte counts and the incidence of 12 cardiovascular diseases: a CALIBER cohort study. Open Heart. 2016 Sep 5;3(2):e000477. doi: 10.1136/openhrt-2016-000477. eCollection 2016. PMID: 27621833 Timmis A et al. Prolonged dual antiplatelet therapy in stable coronary disease: comparative observational study of benefits and harms in unselected versus trial populations. BMJ. 2016 Jun 22;353:i3163. PMID: 27334486 Walker S et al. Long-term healthcare use and costs in patients with stable coronary artery disease: a population-based cohort using linked health records (CALIBER). Eur Heart J Qual Care Clin Outcomes. 2016 Jan 20;2(2):125-140. doi: 10.1093/ehjqcco/qcw003. PMID: 27042338 George J et al. How Does Cardiovascular Disease First Present in Women and Men? Incidence of 12 Cardiovascular Diseases in a Contemporary Cohort of 1,937,360 People. Circulation. 2015 Oct 6;132(14):1320-8. doi: 10.1161/CIRCULATIONAHA.114.013797. Epub 2015 Sep 1. PMID: 26330414 Morley KI et al. Defining disease phenotypes using national linked electronic health records: a case study of atrial fibrillation. PLoS One. 2014 Nov 4;9(11):e110900. doi: 10.1371/journal.pone.0110900. eCollection 2014. PMID: 25369203 Pujades-Rodriguez M et al. Heterogeneous associations between smoking and a wide range of initial presentations of cardiovascular disease in 1937360 people in England: lifetime risks and implications for risk prediction. Int J Epidemiol. 2015 Feb;44(1):129-41. doi: 10.1093/ije/dyu218. Epub 2014 Nov 20. PMID: 25416721 Pujades-Rodriguez M et al. Socioeconomic deprivation and the incidence of 12 cardiovascular diseases in 1.9 million women and men: implications for risk prediction and prevention. PLoS One. 2014 Aug 21;9(8):e104671. doi: 10.1371/journal.pone.0104671. eCollection 2014. PMID: 25144739 Rapsomaniki E et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people. Lancet. 2014 May 31;383(9932):1899-911. doi: 10.1016/S0140-6736(14)60685-1. PMID: 24881994 Shah AD et al. Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1.9 million people. Lancet Diabetes Endocrinol. 2015 Feb;3(2):105-13. doi: 10.1016/S2213-8587(14)70219-0. Epub 2014 Nov 11. PMID: 25466521 Rapsomaniki E et al. Prognostic models for stable coronary artery disease based on electronic health record cohort of 102 023 patients. Eur Heart J. 2014 Apr;35(13):844-52. doi: 10.1093/eurheartj/eht533. Epub 2013 Dec 17. PMID: 24353280