Indian J Gastroenterol (November–December 2016) 35(6):419–424 DOI 10.1007/s12664-016-0699-z
ORIGINAL ARTICLE
Socioeconomic impact of alcohol in patients with alcoholic liver disease in eastern India Shivaram Prasad Singh 1 & Pradeep Kumar Padhi 1 & Jimmy Narayan 1 & Ayaskanta Singh 1 & Girish Kumar Pati 1 & Preetam Nath 1 & Prasant Kumar Parida 1 & Sunil Mishra 1
Received: 22 September 2015 / Accepted: 17 September 2016 / Published online: 19 October 2016 # Indian Society of Gastroenterology 2016
Abstract Aim The aim of this study is to estimate the socioeconomic impact of alcohol use on patients with alcoholic liver disease (ALD) and their families. Methods The demographic and socioeconomic data were collected from hospitalized ALD patients and attendants using a self designed non validated questionnaire and analyzed. Results Study subjects included 100 consecutive ALD patients (all males). Sixty percent were between 30 and 50 years. Most were married (96 %), literate (63 %), either businessmen (37 %) or employed (30 %) and belonged to middle socioeconomic class. Ninety percent started alcohol use before age 30 years and half during teenage. Mean alcohol intake was 190 mL/day (mean duration 23 years); 60 % consumed alcohol daily. Concomitant tobacco abuse was noted in 79 %. Average expenditure on alcohol was Rs 3800/month. Average hospitalizations for ALD related problems was 2.6 times/year with average expenditure of INR 30,000 (~440 US$) during each hospitalization. For treatment expenses, 86 % of patients borrowed money from friends/relatives, 36 % used saving deposits, and 4 % sold personal belongings. Eleven percent lost their job, and 7 % sold immovable property. In 43 % of cases, children were deprived of education. Besides, 52 % had disturbed social and family life, 34 % abused their spouse, 20 % suffered accidents, and 37 % indulged in physical violence.
* Shivaram Prasad Singh [email protected]
1
Department of Gastroenterology, Sriram Chandra Bhanj Medical College, Cuttack, Odisha 753 007, India
Conclusion Majority of ALD patients and their families had disturbed social and family life and incurred severe financial loss arising of alcohol use. Keywords Alcoholic liver disease . Alcohol related disorder . Alcohol users . Odisha State Treatment Fund . Social impact . Socioeconomic factor . The International Labor Organization
Introduction Alcohol is one of the leading causes of death and disability globally. About two billion people worldwide consume alcohol and of these, about one third (nearly 76.3 million) are likely to have one or more diagnosable alcohol use disorder [1]. 3.2 % of all deaths are attributed to alcohol [2]. WHO estimates for the South East Asian countries indicate that one fourth to one third of male population drink alcohol [3] with increasing trend among women [4]. In India, the estimated number of alcohol users is 63 million with 17.4 % of them being dependent users [5] and 20 % to 30 % of hospital admissions are due to alcohol-related problems [6]. Alcohol consumption has been identified not only as a risk factor for many health-related problems but also for social and economic problems of the community. Traditionally, the adverse effects of alcohol use have been linked only to the acute immediate effects (i.e. state of drunkenness) and long-term effects of alcohol dependence or alcohol-related health problems [6]. There is growing evidence that apart from the total quantum, the pattern of consumption (frequency of use, drinking to intoxication, binge drinking) plays an important role in many of the public health problems (injuries, violence, etc.) consequent to alcohol use [7]. World Health Organization (WHO) report identified alcohol as being responsible for
420
nearly 60 types of disorders and injuries (WHO, 2000). Alcohol consumption has been recognized as the leading health-related risk factor, next to underweight, unsafe sex, hypertension, and tobacco use (WHO, 2002). Further, alcohol has also been a known risk factor for increasing crimes, work absenteeism, loss of productivity, damage to property, and physical and emotional abuse of women and children. These in turn have a cascading effect on the healthy socioeconomic growth of families and communities. However, there is insufficient information on social, economic, health, and psychological impact of alcohol use in alcoholic liver disease (ALD) patients in published literature. Therefore, it is necessary to understand the social and economic costs of this disease to estimate the burden it imposes on society and draw attention of all stake holders to pave the way for initiation of preventive action to contain this menace. We undertook a study to estimate the socioeconomic impact of alcohol use on patients with ALD and their families in coastal eastern India.
Indian J Gastroenterol (November–December 2016) 35(6):419–424
issues (i.e. duration of work absenteeism, lost job), economic aspects (i.e. source of health expenditure, disruption of education in children), emotional and psychological aspects (abusing family members, violent behaviors in community) and legal aspects (shuffle with police, suicide or homicide)^. The mean alcohol attributable expenditure was calculated for each individual. The mean alcohol attributable expenditure was calculated by adding up the total expenditure incurred by the patient in purchasing alcohol per month, the monthly treatment expenditure after discharge from the hospital, and the expenditure made during hospitalization for ALD in the past 1 year divided by 12. This information was used for assessing the overall economic impact due to alcohol use. The available data were utilized to arrive at the socioeconomic burden and impact at the family level in the analysis. The present study was approved by the institutional ethics committee of the S C B Medical College, Cuttack, Odisha.
Results Methods The study was carried out in the Gastroenterology Department of Shrirama Chandra Bhanj (SCB) Medical College and Hospital, Cuttack, Odisha from 1 August 2013 to 31 July 2014. Patients of age more than 18 years with diagnosis of ALD, diagnosed on the basis of history, clinical examination, liver function test imaging, and endoscopy were included as study participants. Only patients with unequivocal evidence of chronic alcoholic liver disease with either demonstration of portosystemic collaterals or chronic liver disease (CLD) on imaging and esophageal varices on endoscopy were included in the study. Patients with CLD of other etiology such as due to hepatitis B and C infections, Wilson disease, hemochromatosis, diabetes mellitus, and nonalcoholic steatohepatitis were excluded from the study. An informed consent was taken from each patient both in oral and written forms. Those patients, who were unwilling for informed consent, were excluded from study protocol. The demographic and socioeconomic data were collected prospectively from consecutive hospitalized ALD patients and their attendants, analyzed, and expressed in percentage. BThe data collected included sociodemographic details, (i.e. age, sex, occupation, marital status), health and economic status of individuals (i.e. personal monthly income, savings details, frequency of medical check up including hospitalization due to alcohol related illness), information pertaining to use of alcohol (i.e. age of starting alcohol intake, duration of alcohol intake, type, frequency and amount of alcohol intake, any family history of alcohol intake and the amount spent per month for alcohol intake), social aspects (i.e. disturbed family life due to frequent quarreling, broken relationship with family members), occupation related
A total of 100 consecutive ALD patients admitted to the Gastroenterology Department of S C B Medical College and Hospital, Cuttack were studied from 1 August 2013 to 31 July 2014. All the patients were males. Sixty percent (two thirds) of alcohol users were in the age group 30–50 years, 3 % were below 30 years of age, and 37 % were beyond 50 years of age. Sixty-five percent of patients were from rural areas. Sixty-nine percent were literate either businessman (39 %) or employed (30 %), and others are farmer (10 %) and laborers (10 %) (Table 1). Ninety percent of patients started alcohol use before age 30 years and half (50 %) of them in the teenage (11–20 years) and 21 % before age 18 years. Ninety-six percent of patients are married (Tables 1 and 2). Fifty-three percent of patients had a monthly income between INR 5000–10,000, 18 % of patients had an income INR 25,000 monthly income (Table 1). In 63 % of patients, there was a family history of drinking, such as with father (47 %), brother (50 %), son (12 %), and wife (5 %) (Table 2). Sixty percent of patients do not have saving bank accounts, only 40 % of patients had savings at banks, insurance policies, or savings at home. Eighty percent of patients consumed both country liquor and foreign liquor, 08 % of patients consumed only foreign liquor, and 12 % of patients only country liquor (Table 2). Sixty percent of patients consumed alcohol daily, 15 % of patients 6 days/week, 12 % of patients 5 days/week, and 13 % of patient’s
ORIGINAL ARTICLE
Socioeconomic impact of alcohol in patients with alcoholic liver disease in eastern India Shivaram Prasad Singh 1 & Pradeep Kumar Padhi 1 & Jimmy Narayan 1 & Ayaskanta Singh 1 & Girish Kumar Pati 1 & Preetam Nath 1 & Prasant Kumar Parida 1 & Sunil Mishra 1
Received: 22 September 2015 / Accepted: 17 September 2016 / Published online: 19 October 2016 # Indian Society of Gastroenterology 2016
Abstract Aim The aim of this study is to estimate the socioeconomic impact of alcohol use on patients with alcoholic liver disease (ALD) and their families. Methods The demographic and socioeconomic data were collected from hospitalized ALD patients and attendants using a self designed non validated questionnaire and analyzed. Results Study subjects included 100 consecutive ALD patients (all males). Sixty percent were between 30 and 50 years. Most were married (96 %), literate (63 %), either businessmen (37 %) or employed (30 %) and belonged to middle socioeconomic class. Ninety percent started alcohol use before age 30 years and half during teenage. Mean alcohol intake was 190 mL/day (mean duration 23 years); 60 % consumed alcohol daily. Concomitant tobacco abuse was noted in 79 %. Average expenditure on alcohol was Rs 3800/month. Average hospitalizations for ALD related problems was 2.6 times/year with average expenditure of INR 30,000 (~440 US$) during each hospitalization. For treatment expenses, 86 % of patients borrowed money from friends/relatives, 36 % used saving deposits, and 4 % sold personal belongings. Eleven percent lost their job, and 7 % sold immovable property. In 43 % of cases, children were deprived of education. Besides, 52 % had disturbed social and family life, 34 % abused their spouse, 20 % suffered accidents, and 37 % indulged in physical violence.
* Shivaram Prasad Singh [email protected]
1
Department of Gastroenterology, Sriram Chandra Bhanj Medical College, Cuttack, Odisha 753 007, India
Conclusion Majority of ALD patients and their families had disturbed social and family life and incurred severe financial loss arising of alcohol use. Keywords Alcoholic liver disease . Alcohol related disorder . Alcohol users . Odisha State Treatment Fund . Social impact . Socioeconomic factor . The International Labor Organization
Introduction Alcohol is one of the leading causes of death and disability globally. About two billion people worldwide consume alcohol and of these, about one third (nearly 76.3 million) are likely to have one or more diagnosable alcohol use disorder [1]. 3.2 % of all deaths are attributed to alcohol [2]. WHO estimates for the South East Asian countries indicate that one fourth to one third of male population drink alcohol [3] with increasing trend among women [4]. In India, the estimated number of alcohol users is 63 million with 17.4 % of them being dependent users [5] and 20 % to 30 % of hospital admissions are due to alcohol-related problems [6]. Alcohol consumption has been identified not only as a risk factor for many health-related problems but also for social and economic problems of the community. Traditionally, the adverse effects of alcohol use have been linked only to the acute immediate effects (i.e. state of drunkenness) and long-term effects of alcohol dependence or alcohol-related health problems [6]. There is growing evidence that apart from the total quantum, the pattern of consumption (frequency of use, drinking to intoxication, binge drinking) plays an important role in many of the public health problems (injuries, violence, etc.) consequent to alcohol use [7]. World Health Organization (WHO) report identified alcohol as being responsible for
420
nearly 60 types of disorders and injuries (WHO, 2000). Alcohol consumption has been recognized as the leading health-related risk factor, next to underweight, unsafe sex, hypertension, and tobacco use (WHO, 2002). Further, alcohol has also been a known risk factor for increasing crimes, work absenteeism, loss of productivity, damage to property, and physical and emotional abuse of women and children. These in turn have a cascading effect on the healthy socioeconomic growth of families and communities. However, there is insufficient information on social, economic, health, and psychological impact of alcohol use in alcoholic liver disease (ALD) patients in published literature. Therefore, it is necessary to understand the social and economic costs of this disease to estimate the burden it imposes on society and draw attention of all stake holders to pave the way for initiation of preventive action to contain this menace. We undertook a study to estimate the socioeconomic impact of alcohol use on patients with ALD and their families in coastal eastern India.
Indian J Gastroenterol (November–December 2016) 35(6):419–424
issues (i.e. duration of work absenteeism, lost job), economic aspects (i.e. source of health expenditure, disruption of education in children), emotional and psychological aspects (abusing family members, violent behaviors in community) and legal aspects (shuffle with police, suicide or homicide)^. The mean alcohol attributable expenditure was calculated for each individual. The mean alcohol attributable expenditure was calculated by adding up the total expenditure incurred by the patient in purchasing alcohol per month, the monthly treatment expenditure after discharge from the hospital, and the expenditure made during hospitalization for ALD in the past 1 year divided by 12. This information was used for assessing the overall economic impact due to alcohol use. The available data were utilized to arrive at the socioeconomic burden and impact at the family level in the analysis. The present study was approved by the institutional ethics committee of the S C B Medical College, Cuttack, Odisha.
Results Methods The study was carried out in the Gastroenterology Department of Shrirama Chandra Bhanj (SCB) Medical College and Hospital, Cuttack, Odisha from 1 August 2013 to 31 July 2014. Patients of age more than 18 years with diagnosis of ALD, diagnosed on the basis of history, clinical examination, liver function test imaging, and endoscopy were included as study participants. Only patients with unequivocal evidence of chronic alcoholic liver disease with either demonstration of portosystemic collaterals or chronic liver disease (CLD) on imaging and esophageal varices on endoscopy were included in the study. Patients with CLD of other etiology such as due to hepatitis B and C infections, Wilson disease, hemochromatosis, diabetes mellitus, and nonalcoholic steatohepatitis were excluded from the study. An informed consent was taken from each patient both in oral and written forms. Those patients, who were unwilling for informed consent, were excluded from study protocol. The demographic and socioeconomic data were collected prospectively from consecutive hospitalized ALD patients and their attendants, analyzed, and expressed in percentage. BThe data collected included sociodemographic details, (i.e. age, sex, occupation, marital status), health and economic status of individuals (i.e. personal monthly income, savings details, frequency of medical check up including hospitalization due to alcohol related illness), information pertaining to use of alcohol (i.e. age of starting alcohol intake, duration of alcohol intake, type, frequency and amount of alcohol intake, any family history of alcohol intake and the amount spent per month for alcohol intake), social aspects (i.e. disturbed family life due to frequent quarreling, broken relationship with family members), occupation related
A total of 100 consecutive ALD patients admitted to the Gastroenterology Department of S C B Medical College and Hospital, Cuttack were studied from 1 August 2013 to 31 July 2014. All the patients were males. Sixty percent (two thirds) of alcohol users were in the age group 30–50 years, 3 % were below 30 years of age, and 37 % were beyond 50 years of age. Sixty-five percent of patients were from rural areas. Sixty-nine percent were literate either businessman (39 %) or employed (30 %), and others are farmer (10 %) and laborers (10 %) (Table 1). Ninety percent of patients started alcohol use before age 30 years and half (50 %) of them in the teenage (11–20 years) and 21 % before age 18 years. Ninety-six percent of patients are married (Tables 1 and 2). Fifty-three percent of patients had a monthly income between INR 5000–10,000, 18 % of patients had an income INR 25,000 monthly income (Table 1). In 63 % of patients, there was a family history of drinking, such as with father (47 %), brother (50 %), son (12 %), and wife (5 %) (Table 2). Sixty percent of patients do not have saving bank accounts, only 40 % of patients had savings at banks, insurance policies, or savings at home. Eighty percent of patients consumed both country liquor and foreign liquor, 08 % of patients consumed only foreign liquor, and 12 % of patients only country liquor (Table 2). Sixty percent of patients consumed alcohol daily, 15 % of patients 6 days/week, 12 % of patients 5 days/week, and 13 % of patient’s
