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Preventing violence-related injuries in England and Wales: a panel study examining the impact of on-trade and off-trade alcohol prices
  1. Nicholas Page1,
  2. Vaseekaran Sivarajasingam1,
  3. Kent Matthews2,
  4. Saeed Heravi2,
  5. Peter Morgan2,
  6. Jonathan Shepherd1
  1. 1Violence Research Group, School of Dentistry, Cardiff University, Cardiff, UK
  2. 2Cardiff Business School, Cardiff University, Cardiff, UK
  1. Correspondence to Dr Vaseekaran Sivarajasingam, School of Dentistry, Cardiff University, Heath Park, Cardiff CF14 4XY, UK; sivarajasingam{at}


Objective To examine the influence of real on-trade and off-trade alcohol prices and socioeconomic and environmental factors on rates of violence-related emergency department (ED) attendances in England and Wales over an 8-year period.

Methods Anonymised injury data which included attendance date, age and gender of patients aged over 18 years who reported injury in violence were collected from a structured sample of 100 EDs across England and Wales between 1 January 2005 and 31 December 2012. Alcohol prices and socioeconomic measures were obtained from the UK Office for National Statistics. Panel techniques were used to derive a statistical model.

Results Real on-trade (β=−0.661, p<0.01) and off-trade (β=−0.277, p<0.05) alcohol prices were negatively related with rates of violence-related ED attendance among the adult population of England and Wales, after accounting for the effects of regional poverty, income inequality, youth spending power and seasonal effects. It is estimated that over 6000 fewer violence-related ED attendances per year in England and Wales would result from a 1% increase in both on-trade and off-trade alcohol prices above inflation. Of the variables studied, changes in regional poverty and income inequality had the greatest effect on violence-related ED attendances in England and Wales.

Conclusions Small increases in the price of alcohol, above inflation, in both markets, would substantially reduce the number of patients attending EDs for treatment of violence-related injuries in England and Wales. Reforming the current alcohol taxation system may be more effective at reducing violence-related injury than minimum unit pricing.

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  • Twitter Follow Nicholas Page at @Nick_Alan_Page

  • Contributors NP, KM and VS designed the study. VS and JS contacted the clinical leads and collected the anonymised injury records. NP, SH and PM calculated the alcohol price indices. PM, NP and KM conducted statistical analysis. NP, VS and JS prepared the manuscript. All authors commented on the final draft and approved the manuscript prior to submission.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Anonymised injury records were collected from participating emergency departments under the agreement that the data would not be shared with external parties.