Key findings

  • Alcohol-specific deaths disproportionately affected males aged 35-54 years, residents of urban areas and the most deprived areas.

After accounting for other factors (such as age and area deprivation):

  • Unemployment and economic inactivity were associated with higher mortality risk for both sexes.

  • Having a disability was associated with higher mortality risk for both sexes.

  • For males, living alone, or being a child in a lone-parent household, was associated with higher mortality risk.

  • Living in social-rented housing was associated with increased risk for both sexes.

  • Being divorced or separated was associated with increased risk for both sexes; single females also had increased mortality risk.

Background

Alcohol-specific deaths remain a major public health challenge in Northern Ireland, with profound impacts on individuals, families and communities. Based on registration data (all ages), mortality rates have risen sharply over the last decade, with males and those aged 45-64 years particularly affected. Alcohol-specific deaths increased by 65.5% from 206 in 2013 to 341 in 2023 (see reference 1). Among those aged 15-64 years, alcohol-specific deaths were the third leading cause of death between 2015 and 2023, behind cancer and circulatory conditions (see main report, Annex 3, Figure 4A).

This study examined personal, household and area characteristics associated with alcohol-specific deaths, providing insights beyond Accredited Official Statistics (see reference 1). This brief is part of a series alongside suicide and drug-related deaths. The full report is available on the NISRA-led research website.

Data source

Analysis used the Northern Ireland Mortality study, linking 2011 Census records to registered deaths from April 2011 to September 2022. The dataset includes 2,375 alcohol-specific deaths (86.3% of all registered alcohol-specific deaths).

Key strengths of NIMS include:

  1. Nationally representative data enabling comparisons of characteristics between those that died and the general population.
  2. Sufficient sample sizes for detailed subgroup analyses.
  3. Supports modelling to quantify mortality risk across diverse groups.

Characteristics

Characteristics of those who died from an alcohol-specific death compared with the general population:

Age and sex:

  • Males accounted for 66.5% of alcohol-specific deaths among 16-64 year-olds (but comprised 48.9% of the general population aged 16-64 years).
  • Males aged 35-54 years: 73.4% of alcohol-specific deaths (but comprised 43.1% of the male population aged 16-64 years).

Marital status:

  • Divorced or separated: 31.0% of deaths (10.2% of the population).

Education and employment:

  • No qualifications: 41.4% of deaths (21.4% of the population).
  • Economically inactive: 50.5% of deaths (27.8% of the population).
  • Unemployed: 10.9% of deaths (5.5% of the population).

Health factors:

  • Self-reported poor mental health: 29.2% of deaths (7.7% of the population).
  • Self-reported disability: 50.5% of deaths (17.2% of the population).

Housing and living arrangements:

  • Social housing residents: 35.5% of deaths (12.8% of the population).
  • Living alone: 40.2% of deaths (10.6% of the population).

Geographic patterns:

  • Greater Belfast: 39.6% of deaths (34.0% of the population).
  • Urban areas: 78.6% of deaths (63.8% of the population).
  • 27.6% of deaths were in the 20% most deprived areas.

Who faces the highest risk?

Figure 1 shows Hazard Ratios for alcohol-specific deaths by sex, comparing each characteristic with its specific reference group (e.g. employed, married, no disability). Full modelling details are in the main report available at NISRA-led research.

Figure 1: Mortality hazard ratios (with 95% confidence intervals) for alcohol-specific deaths, 16-64 years by sex: April 2011 to September 2022

Figure 1 shows which groups had higher risk of alcohol-specific death for males and females aged 16–64 years in Northern Ireland (April 2011–September 2022).

Figure 1: Note and interpretation

Hazard ratios (HRs) show how much more likely death is for a given group compared to its reference group, after adjusting for other factors. For example, unemployed males (HR: 2.15) were 2.15 times more likely to die than employed males while economically inactive females (HR: 1.63) had a 63% increased risk of an alcohol-specific death compared to employed females.

These associations do not imply causation but highlight key patterns for targeting prevention efforts.


Key modelling insights

Employment status:

  • Unemployment (vs employment) more than doubled the risk for males (HR: 2.15) and females (HR: 2.51).
  • Economic inactivity (vs employment) was also associated with elevated risk - 89% higher for males and 63% higher for females.

Marital status:

  • Being divorced or separated (vs married) was associated with a 75% increase in risk for males and more than double the risk for females (HR: 2.39).
  • Single females also faced an 86% higher risk compared with married females.

Living arrangements:

  • Living in social-rented accommodation (vs owner-occupied) was associated with increased risk for both males (80%) and females (51%).
  • Among males, living alone (vs living as part of a couple household) more than doubled the risk (HR: 2.44).
  • For males, being a child in a lone parent household was associated with a 70% higher risk.
  • Among males, other shared living arrangements (e.g. unrelated individuals sharing accommodation) were associated with a 52% increased risk.

Health factors

  • Having a disability increased the risk by 63% for males and more than doubled the risk for females (HR: 2.12).
  • Reporting poor mental health alone (i.e. without other conditions) increased risk by 40% for females.

Urban residence

  • Living in an urban area (vs rural) was associated with increased risk - 49% higher for males (not shown in Figure 1) and 42% higher for females.

Note: all reference groups are shown in Figure 1.

Discussion

This study reinforces established patterns: alcohol-specific deaths are more common among males, particularly those aged 35-54 years, and among residents of urban areas. The analysis also highlights several additional insights:

  • Unemployment and economic inactivity were strongly associated with alcohol-specific mortality.
  • Divorced or separated individuals faced higher mortality risks.
  • Living in social-rented housing was linked to increased risk, as was living alone for males.
  • Having a disability was associated with higher mortality risk for both sexes.

It is important to note that the direction of some of these associations is unclear. For example, harmful alcohol use may both contribute to, and result from, relationship breakdown.

Policy context

Northern Ireland’s strategies addressing substance use, inequalities and economic inactivity include:

This research highlights the importance of addressing economic inactivity, social isolation, and socio-economic inequalities. Collaboration is ongoing with stakeholders in the Department of Health and in the Public Health Agency to maximise the policy impact of this work.

Further information

Definitions:

  • Economic inactivity: not working or seeking work due to reasons such as long-term illness or caring responsibilities.
  • Unemployment: not working but actively seeking employment.
  • Disability: self-reported health problems or disabilities lasting, or expected to last, at least 12 months and which limit daily activities.
  • Poor mental health: self-reported emotional, psychological or mental health condition (such as depression or schizophrenia).
  • Greater Belfast includes residents of the Belfast, Antrim and Newtownabbey, and Lisburn and Castlereagh Local Government Districts (see reference 2) at the baseline in 2011.

Note: see the main report for full definitions.

Acknowledgements

The help provided by the staff of the Northern Ireland Mortality Study (NIMS) and the NILS Research Support Unit is acknowledged. The NIMS is funded by the Health and Social Care Research and Development Division of the Public Health Agency (HSC R&D Division) and NISRA. The NILS-RSU is funded by the Economic & Social Research Council and the Northern Ireland Government. We also thank colleagues in NISRA, the Department of Health and the Public Health Agency who contributed to the development of this brief.

Contact details

Research team John Hughes, Brian Foley, Jana Ross, Carmel Colohan, and Deborah Lyness (all Administrative Research Unit, NISRA)

For further information on this research, please contact

Accessibility contact

Please contact Dissemination Branch for assistance with accessibility requirements or alternative formats. Contact details are:

Email:

Telephone: +44 (0)300 200 7836

Dissemination Branch
NISRA
Colby House
Stranmillis Court
BELFAST
BT9 5RR