Background Alcohol-related harms, most commonly liver disease-related, are a public health priority in Scotland. Previous research has identified variations in liver disease mortality endpoints using country of birth as a proxy for ethnicity in the UK. We report ethnic differences in the incidence of alcohol-related and liver disease using an adequate measure of ethnicity in Scotland.

Methods Using the Scottish Health & Ethnicity Linkage Study (SHELS), linking NHS hospital admissions and mortality to the Scottish census 2001, we explored ethnic differences in incidence (2001-2010) of specific alcohol-related diseases (ARD) (ISD definition for ARD, all liver diseases, alcoholic liver disease) in Scotland. Risk ratios (RR) were calculated using Poisson regression with robust variance and multiplied by 100, by gender and adjusted for age. The White Scottish population was the standard reference population (100).

Results For alcohol-related diseases, White Irish had about a 2 fold higher risk for both men (RR 225 [95% CI 196, 258]) and women (182 [147, 224]); other British women also had a 25% higher risk (126 [107, 148]). Other White British men had a 10% lower risk (89 [80, 98]), with risks even lower in Pakistani men (66 [55, 78]) and women (49 [30, 78]) and Chinese men (47 [38, 58]). For alcoholic liver disease, White Irish had about a 50% higher risk of ALD for both men (165 [130, 209]) and women (150 [117, 193]). Other White British men had about a third lower risk of ALD (61 [50, 75]), as did Pakistani men (62 [42, 90]) and a composite of South Asian women (75 [58, 91]). For all liver diseases, some ethnic groups had about a third higher risk: Chinese men (144 [50, 175]) and women (133 [107, 165]) as well as Pakistani women (140 [112, 176]). Lower risks for all liver diseases occurred in other White British men (72 [62, 83]) and women (77 [69, 87]) and other White women (74 [64, 90]).

Conclusion These findings show persistent differences in incidence by ethnicity for both alcohol-related and liver disease in Scotland, with important health implications throughout the UK. New policy, research and practical action are required to address these differences.