The temporal relationship between per capita alcohol consumption and harm: a systematic review of time lag specifications in aggregate time series analyses

Interrupted Time Series Design and Analyses in Health Policy Assessment

Interrupted time series design is a quasi-experimental study design commonly used to evaluate the impact of a particular intervention (e.g., a health policy implementation) on a specific outcome. Two of the most often recommended analytical approaches to interrupted time series analysis are autoregressive integrated moving average (ARIMA) and Generalized Additive Models (GAM). We conducted simulation tests to determine the performance differences between ARIMA and GAM methodology across different policy effect sizes, with or without seasonality, and with or without misspecification of policy variables. We found that ARIMA exhibited more consistent results under certain conditions, such as with different policy effect sizes, with or without seasonality, while GAM were more robust when the model was misspecified. Given these findings, the variation between the models underscores the need for careful model selection and validation in health policy studies.

The role of alcohol control policies in the reversal of alcohol consumption levels and resulting attributable harms in China

Yearly adult per capita consumption of alcohol in China between 2016 and 2019 decreased by 2.4 litres of pure alcohol, or 33%. According to the World Health Organization, this decrease in consumption was accompanied by reductions in alcohol-attributable mortality of 23% between 2015 and 2019. This paper examines the contribution of alcohol control policies in China to these public health gains. A systematic search of the literature was conducted on alcohol control policies and their effectiveness in China as part of a larger search of all countries in WHO Western Pacific Region. In addition to articles on empirical evidence on the impact of such alcohol control policies, we also searched for reviews. The plausibility of changes of traditional alcohol control policies (taxation increases, availability restrictions, restriction on advertisement and marketing, drink-driving laws, screening and brief interventions) in explaining reductions of consumption levels and attributable mortality rates was explored. There was some progress in the successful implementation of strict drink-driving policies, which could explain reductions in traffic injuries, including fatalities. Other traditional alcohol control policies seem to have played a minimal role in reducing alcohol consumption and attributable harms during the time period 2016-2019. However, an anti-corruption campaign was extensive enough to have substantially contributed to these reductions. The campaign prohibited the consumption of alcoholic beverages in everyday life of government officials and thus contributed to a de-normalization of alcohol. While this anti-corruption campaign was the only policy to potentially explain marked decreases in levels of alcohol consumption and attributable mortality, more detailed research is required to determine exactly how the campaign achieved these decreases.

Modelling the longer-term health and health inequality impacts of changes in alcohol consumption during the COVID-19 pandemic in England

BACKGROUND

Alcohol consumption changed substantially during the COVID-19 pandemic for many people. This study quantified how these changes in drinking varied across the population and their potential longer-term impact on health and health inequalities.

METHODS

We analyzed data from the Alcohol Toolkit Study to estimate how alcohol consumption changed during the pandemic (April 2020-November 2021) and how these changes varied with age, sex, drinking level and socioeconomic position. We combined these estimates with a range of alternative scenarios of future alcohol consumption and used the Sheffield Alcohol Policy Model to assess the long-term health and health inequality impacts of these changes.

RESULTS

Alcohol consumption in 2020-21 increased in heavier drinkers but fell in moderate drinkers. If alcohol consumption returns to pre-pandemic levels in 2022, we estimate a total of 42 677 additional hospital admissions and 1830 deaths over 20 years because of these changes. If consumption remains at 2021 levels in the long-term these figures rise to 355 832 and 12 849, respectively. In all scenarios, the biggest increase in harm occurs in the most deprived 20% of the population.

CONCLUSIONS

Pandemic-era changes in alcohol consumption are likely to have a significant negative impact on public health and health inequalities, even under optimistic assumptions about future drinking.

Digital Alcohol Interventions Could Be Part of the Societal Response to Harmful Consumption, but We Know Little About Their Long-Term Costs and Health Outcomes

Alcohol consumption causes both physical and psychological harm and is a leading risk factor for noncommunicable diseases. Digital alcohol interventions have been found to support those looking for help by giving them tools for change. However, whether digital interventions can help tackle the long-term societal consequences of harmful alcohol consumption in a cost-effective manner has not been adequately evaluated. In this Viewpoint, we propose that studies of digital alcohol interventions rarely evaluate the consequences of wider dissemination of the intervention under study, and that when they do, they do not take advantage of modeling techniques that allow for appropriately studying consequences over a longer time horizon than the study period when the intervention is tested. We argue that to help decision-makers to prioritize resources for research and dissemination, it is important to model long-term costs and health outcomes. Further, this type of modeling gives important insights into the context in which interventions are studied and highlights where more research is required and where sufficient evidence is available. The viewpoint therefore invites the researcher not only to reflect on which interventions to study but also how to evaluate their long-term consequences.

Economic costs of alcohol consumption in Thailand, 2021

BACKGROUND

Alcohol is one of the leading risk factors contributing to avoidable economic loss worldwide. Estimates from the economic cost of alcohol consumption studies play an important role in prioritizing healthcare resource use, supporting policy decisions, and justifying budgets for alcohol policy. This study aimed to estimate the economic burden associated with alcohol consumption in Thailand in 2021.

METHODS

Prevalence-based cost of illness methodology was employed. The following costs were included in the analysis: healthcare costs; cost of law enforcement; cost of property damage due to road traffic accidents; cost of premature mortality; and cost of absenteeism from out-patient hospital visits and hospitalization. Human capital approach was adopted. All costs were presented in Thai baht, 2021.

RESULTS

Alcohol consumption incurred a total estimated economic cost of 165,450.5 million baht, equivalent to 1.02% of Gross Domestic Product (GDP) and 2500 baht per capita. Cost of premature mortality was estimated at 157,918.7 million baht and accounted for the largest proportion of the total cost (95.45%). Healthcare cost was found to be the second highest share representing 4370.1 million baht (2.7% of the total cost). The number of premature death attributable to alcohol consumption in 2021 was estimated at 22,804.

CONCLUSIONS

Alcohol continues to impose a substantial economic burden in Thailand. Enforcement of existing well-formulated alcohol control policies is urgently required to mitigate the economic impact of alcohol consumption in the country.

The effects of alcohol tax policies on alcohol consumption and alcohol use disorders in Mainland of China: an interrupted time series analysis from 1961-2019

Background: Overwhelming evidence suggests that increasing alcohol taxes is an effective strategy for curbing alcohol consumption. However, research on the effects of such strategies in low- and middle-income nations is limited.Objective: The aim is to explore the temporal effect of alcohol tax policy in China.Methods: We employ interrupted time series analysis to investigate the temporal effects of tax policy changes on alcohol consumption and related consequences in Mainland China from 1961 to 2019. The study population, the total population of mainland region of China, aged more than 15 years.Results: The results show that the volume tax policy, which was announced in 2000 and implemented in 2001,  led to an immediate reduction in the alcohol consumption (coefficient = -0.429, p < .001). Following the implementation of higher alcohol taxes in 1998 and 2001, the prevalence of alcohol use disorders (AUDs) and related years lived with disability (YLDs) gradually decreased. The relaxation of tax policy in 2006 led to a significant increase in alcohol consumption, both immediately (coefficient = 0.406, p < .001) and in the middle term (coefficient = 0.495, p < .001), as well as contribute to an immediate or medium term significant increase in the prevalence of AUDs (coefficient = 0.038, p = .010; coefficient = 0.032, p < .001) and YLDs (coefficient = 4.363, p = .001; coefficient = 4.226, p < .001).Conclusion: This study demonstrates that changes in alcohol consumption and related consequences (increase or decrease) have followed corresponding changes in alcohol tax policies (easing or tightening), indicating that increasing alcohol taxes can be an effective strategy in China for controlling alcohol consumption and related harms.

Trends in alcohol-related liver disease mortality in Australia: An age-period-cohort perspective

BACKGROUND AND AIMS

There have been few systematic attempts to examine how alcohol-related mortality has changed in Australia, and no studies that have explored cohort effects in alcohol-related mortality. This study uses more than 50 years of data to measure age, period and cohort trends in alcohol-related liver disease (ALD) mortality.

DESIGN, SETTING AND CASES

This was a retrospective age-period-cohort analysis of total Australian ALD mortality data from 1968 to 2020 in Australia. There was a total of 35 822 deaths-27 208 men (76%) and 8614 women (24%).

MEASUREMENTS

Deaths from ALD were grouped into 5-year age groups and periods (e.g. deaths for 20-24-year-olds between 1968 and 1972 were combined).

FINDINGS

ALD mortality peaked in the late 1970s and early 1980s for both men and women. In age-period-cohort models, mortality was highest for cohorts born 1915-30. For example, men born between 1923 and 1927 had a relative risk of 1.58 [95% confidence interval (CI) = 1.52, 1.64] compared with men born between 1948 and 1952. For women, there was an increase in risk for cohorts born in the 1960s [e.g. the 1963-67 cohort had a relative risk (RR) of 1.16 (95% CI = 1.07, 1.25) compared with women born in 1948-52]. For men, there was a broad decline in mortality over time [e.g. in 2020, the RR was 0.87 (95% CI = 0.82, 0.92) compared with the reference year of 2000]. For women, mortality declined until 2000 and has been stable since.

CONCLUSIONS

Alcohol-related liver disease mortality has declined across the Australian population since the 1970s and 1980s partly due to cohort-specific shifts as the highest-risk birth cohorts age. For women, this decline had stalled by the year 2000, and cohorts of women born during the 1960s were at higher risk than earlier cohorts, suggesting the need for thoughtful interventions as this population enters its highest-risk years for ALD mortality.

Evaluating the impact of alcohol minimum unit pricing on deaths and hospitalisations in Scotland: a controlled interrupted time series study

BACKGROUND

Since May 1, 2018, every alcoholic drink sold in Scotland has had minimum unit pricing (MUP) of £0·50 per unit. Previous studies have indicated that the introduction of this policy reduced alcohol sales by 3%. We aimed to assess whether this has led to reductions in alcohol-attributable deaths and hospitalisations.

METHODS

Study outcomes, wholly attributable to alcohol consumption, were defined using routinely collected data on deaths and hospitalisations. Controlled interrupted time series regression was used to assess the legislation's impact in Scotland, and any effect modification across demographic and socioeconomic deprivation groups. The pre-intervention time series ran from Jan 1, 2012, to April 30, 2018, and for 32 months after the policy was implemented (until Dec 31, 2020). Data from England, a part of the UK where the intervention was not implemented, were used to form a control group.

FINDINGS

MUP in Scotland was associated with a significant 13·4% reduction (95% CI -18·4 to -8·3; p=0·0004) in deaths wholly attributable to alcohol consumption. Hospitalisations wholly attributable to alcohol consumption decreased by 4·1% (-8·3 to 0·3; p=0·064). Effects were driven by significant improvements in chronic outcomes, particularly alcoholic liver disease. Furthermore, MUP legislation was associated with a reduction in deaths and hospitalisations wholly attributable to alcohol consumption in the four most socioeconomically deprived deciles in Scotland.

INTERPRETATION

The implementation of MUP legislation was associated with significant reductions in deaths, and reductions in hospitalisations, wholly attributable to alcohol consumption. The greatest improvements were in the four most socioeconomically deprived deciles, indicating that the policy is positively tackling deprivation-based inequalities in alcohol-attributable health harm.

FUNDING

Scottish Government.

Evaluating the Impact of Alcohol Policy on Suicide Mortality: A Sex-Specific Time-Series Analysis for Lithuania

OBJECTIVE

It is reasonable to believe that the alcohol policy environment can impact the suicide mortality rates in a given country, considering the well-known link between alcohol use and death by suicide. The current literature, albeit limited, suggests that an increase in alcohol taxation may result in a decrease in deaths by suicide and that the effect is sex-specific. Therefore, the objective of the current study was to test the impact of three alcohol control policy enactments (in 2008, 2017 and 2018) on suicide mortality among adults 25-74 years of age in Lithuania, by sex.

METHODS

To estimate the unique impact of three alcohol control policies, we conducted interrupted time-series analyses by employing a generalized additive mixed model on monthly sex-specific age-standardized suicide mortality rates from January 2001 to December 2018.

RESULTS

Analyses showed a significant impact of the 2017 (p = 0.016) alcohol control policy on suicide mortality for men only. Specifically, we estimated that in the year following the 2017 policy enactment, approximately 57 (95% CI: 9-107) deaths by suicide were prevented among men, 25-74 years of age. The three policy enactments tested were not found to significantly impact the suicide mortality rate among women.

CONCLUSION

Alcohol control policies involving pricing, which result in a notable decrease in alcohol affordability, could be a cost-effective indirect suicide prevention mechanism in not only countries of the former Soviet Union, but in other high-income countries with a comparable health care system to that in Lithuania. HIGHLIGHTSIncreasing excise tax on alcohol was found to have a sex-specific impact on suicide mortalityThe 2017 alcohol policy prevented 57 deaths by suicide among men, 25-74 years of age, in the following yearAlcohol pricing policies may be a cost-effective indirect suicide prevention mechanism.

Effectiveness of subnational implementation of minimum unit price for alcohol: policy appraisal modelling for local authorities in England

AIMS

Evidence exists on the potential impact of national level minimum unit price (MUP) policies for alcohol. This study investigated the potential effectiveness of implementing MUP at regional and local levels compared with national implementation.

DESIGN

Evidence synthesis and computer modelling using the Sheffield Alcohol Policy Model (Local Authority version 4.0; SAPMLA).

SETTING

Results are produced for 23 Upper Tier Local Authorities (UTLAs) in North West England, 12 UTLAs in North East England, 15 UTLAs in Yorkshire and Humber, the nine English Government Office regions and England as a whole.

CASES

Health Survey for England (HSE) data 2011-13 (n = 24 685).

MEASUREMENTS

Alcohol consumption, consumer spending, retailers' revenues, hospitalizations, National Health Service costs, crimes and alcohol-attributable deaths and health inequalities.

FINDINGS

Implementing a local £0.50 MUP for alcohol in northern English regions is estimated to result in larger percentage reductions in harms than the national average. The reductions for England, North West, North East and Yorkshire and Humber regions, respectively, in annual alcohol-attributable deaths are 1024 (-10.4%), 205 (-11.4%), 121 (-17.4%) and 159 (-16.9%); for hospitalizations are 29 943 (-4.6%), 5956 (-5.5%), 3255 (-7.9%) and 4610 (-6.9%); and for crimes are 54 229 (-2.4%), 8528 (-2.5%), 4380 (-3.5%) and 8220 (-3.2%). Results vary among local authorities; for example, annual alcohol-attributable deaths estimated to change by between -8.0 and -24.8% throughout the 50 UTLAs examined.

CONCLUSIONS

A minimum unit price local policy for alcohol is likely to be more effective in those regions, such as the three northern regions of England, which have higher levels of alcohol consumption and higher rates of alcohol harm than for the national average. In such regions, the minimum unit price policy would achieve larger reductions in alcohol consumption, alcohol-attributable mortality, hospitalization rates, NHS costs, crime rates and health inequalities.

Estimating effects of health policy interventions using interrupted time-series analyses: a simulation study

BACKGROUND

A classic methodology used in evaluating the impact of health policy interventions is interrupted time-series (ITS) analysis, applying a quasi-experimental design that uses both pre- and post-policy data without randomization. In this paper, we took a simulation-based approach to estimating intervention effects under different assumptions.

METHODS

Each of the simulated mortality rates contained a linear time trend, seasonality, autoregressive, and moving-average terms. The simulations of the policy effects involved three scenarios: 1) immediate-level change only, 2) immediate-level and slope change, and 3) lagged-level and slope change. The estimated effects and biases of these effects were examined via three matched generalized additive mixed models, each of which used two different approaches: 1) effects based on estimated coefficients (estimated approach), and 2) effects based on predictions from models (predicted approach). The robustness of these two approaches was further investigated assuming misspecification of the models.

RESULTS

When one simulated dataset was analyzed with the matched model, the two analytical approaches produced similar estimates. However, when the models were misspecified, the number of deaths prevented, estimated using the predicted vs. estimated approaches, were very different, with the predicted approach yielding estimates closer to the real effect. The discrepancy was larger when the policy was applied early in the time-series.

CONCLUSION

Even when the sample size appears to be large enough, one should still be cautious when conducting ITS analyses, since the power also depends on when in the series the intervention occurs. In addition, the intervention lagged effect needs to be fully considered at the study design stage (i.e., when developing the models).

Estimated Impacts of Alcohol Control Policies on NCD Premature Deaths in Thailand

Background: This study aimed to assess the impacts of achieving a 10% alcohol reduction target and different alcohol policy interventions on NCD premature deaths during 2010–2025 in Thailand. Methods: The researchers estimated the impacts on three main NCDs: cancers, cardiovascular diseases, and diabetes. These represent two ideal scenarios, which are the target reduction and five intervention scenarios. These intervention scenarios comprise taxation with 50% price increases, a total ban on advertisements, availability restriction by shortening sales times, early psychological intervention, and combined interventions. Consumption data and mortality trends were obtained from available national data. Relative risks and intervention effects were derived from the literature. Results: Achieving a 10% reduction target would lead to 3903–7997 avoidable NCD deaths. Taxation was the most effective intervention, with the highest number of avoidable NCD deaths, followed by early psychological intervention, availability restriction, and an advertisement ban. A combination of these four interventions would reduce 13,286 NCD deaths among men and 4994 NCD deaths among women, accounting for 46.8% of the NCD mortality target. Conclusion: This study suggests using Thailand as an example for low- and middle-income countries to enhance implementation and enforcement of the recommended effective alcohol policies for achieving the global targets.

Cancer in sub-Saharan Africa: a Lancet Oncology Commission

In sub-Saharan Africa (SSA), urgent action is needed to curb a growing crisis in cancer incidence and mortality. Without rapid interventions, data estimates show a major increase in cancer mortality from 520 348 in 2020 to about 1 million deaths per year by 2030. Here, we detail the state of cancer in SSA, recommend key actions on the basis of analysis, and highlight case studies and successful models that can be emulated, adapted, or improved across the region to reduce the growing cancer crises. Recommended actions begin with the need to develop or update national cancer control plans in each country. Plans must include childhood cancer plans, managing comorbidities such as HIV and malnutrition, a reliable and predictable supply of medication, and the provision of psychosocial, supportive, and palliative care. Plans should also engage traditional, complementary, and alternative medical practices employed by more than 80% of SSA populations and pathways to reduce missed diagnoses and late referrals. More substantial investment is needed in developing cancer registries and cancer diagnostics for core cancer tests. We show that investments in, and increased adoption of, some approaches used during the COVID-19 pandemic, such as hypofractionated radiotherapy and telehealth, can substantially increase access to cancer care in Africa, accelerate cancer prevention and control efforts, increase survival, and save billions of US dollars over the next decade. The involvement of African First Ladies in cancer prevention efforts represents one practical approach that should be amplified across SSA. Moreover, investments in workforce training are crucial to prevent millions of avoidable deaths by 2030. We present a framework that can be used to strategically plan cancer research enhancement in SSA, with investments in research that can produce a return on investment and help drive policy and effective collaborations. Expansion of universal health coverage to incorporate cancer into essential benefits packages is also vital. Implementation of the recommended actions in this Commission will be crucial for reducing the growing cancer crises in SSA and achieving political commitments to the UN Sustainable Development Goals to reduce premature mortality from non-communicable diseases by a third by 2030.

Can alcohol control policies reduce cirrhosis mortality? An interrupted time-series analysis in Lithuania

BACKGROUND AND AIMS

The relationship between alcohol consumption and cirrhosis is well established. Policies that can influence population-level use of alcohol should, in turn, impact cirrhosis. We examined the effect of population-level alcohol control policies on cirrhosis mortality rates in Lithuania - a high-income European Union country with high levels of alcohol consumption.

METHODS

Age-standardized, monthly liver mortality data (deaths per 100,000 adults, aged 15+) from Lithuania were analysed from 2001 to 2018 (n = 216 months) while controlling for economic confounders (gross domestic product and inflation). An interrupted time-series analysis was conducted to estimate the effect of three alcohol control policies implemented in 2008, 2017 and 2018 and the number of cirrhosis deaths averted.

RESULTS

There was a significant effect of the 2008 (P < .0001) and 2017 (P = .0003) alcohol control policies but a null effect of the 2018 policy (P = .40). Following the 2008 policy, the cirrhosis mortality rate dropped from 4.93 to 3.41 (95% CI: 3.02-3.80) deaths per 100,000 adults, which equated to 493 deaths averted. Further, we found that following the 2017 policy, the mortality rate dropped from 2.85 to 2.01 (95% CI: 1.50-2.52) deaths per 100,000 adults, corresponding to 245 deaths averted.

CONCLUSIONS

Our findings support the hypothesis that alcohol control policies can have a significant, immediate effect on cirrhosis mortality. These policy measures are cost-effective and aid in reducing the burden of liver disease.

Effect of extended trading hours on alcohol sales in Norway: study protocol for a stepped wedge cluster-randomized trial

BACKGROUND AND AIMS

Norwegian alcohol policy measures include national restrictions on sales hours and a state monopoly on retail sales. A 1-hour extension of sales hours on Saturdays in the monopoly outlets took effect from September 2020. We aim to evaluate whether increase in sales hours results in (1) an increase in alcohol sales in the monopoly outlets and (2) an increase in total alcohol sales, including substitution effects from beer sales in grocery stores.

DESIGN

The extension of Saturday sales hours is implemented within a stepped wedge cluster-randomized trial design. Block randomization of 62 of the 66 Norwegian trade districts allocated monopoly outlets to one of three sequences regarding date of implementation.

SETTING AND PARTICIPANTS

A total of 228 of 335 in total Norwegian state monopoly outlets are eligible and included.

INTERVENTION

The extension of sales hours is from 3 p.m. to 4 p.m. starting on the first Saturday in (i) September 2020, (ii) December 2020 or (iii) March 2021.

MEASUREMENTS

Growth rates in monthly alcohol sales, measured in litres of pure alcohol, in eligible monopoly outlets (primary outcome) are obtained together with beverage-specific sales and alcohol sales in grocery stores (secondary outcomes). The observation period is set to 72 months prior to and 24 months after implementation.

FINDINGS

Power analyses indicate that this stepped wedge cluster-randomized controlled trial has a power above 90%, even at a high significance level (α = 0.01) and with other conservative model specifications. The planned trial offers a rare opportunity to study possible causal effects of a relatively small change in a widely used alcohol policy measure.

A time-series analysis of the association between alcohol and suicide in Australia

INTRODUCTION

800,000 people die by suicide every year according to World Health Organisation data. Studies have shown associations between alcohol consumption and suicide, with most demonstrating that alcohol consumption increases suicide risk. However, some studies from high consumption countries show results in the opposite direction. This present study examines the association between per capita (PC) alcohol consumption and same year suicide mortality in Australia, and tests for lag effects, between 1910 and 2017.

MATERIALS AND METHODS

Age and gender-specific autoregressive integrated moving average (ARIMA) models were used to examine associations between alcohol consumption PC and suicide mortality rates. Associations between unemployment, divorce, barbiturates access, and the Great Depression and World War II, and suicide were examined.

RESULTS

A 10% increase in PC alcohol consumption was associated with a 5% and 5.1% decrease in overall and male suicide mortality respectively in the same year. However, a 10% increase in PC alcohol consumption was associated with an 5.1% and 5.4% increase in overall and male suicide mortality respectively 12 years later. This association differed among age groups and was significant in the male population only. Unemployment, divorce, the Great Depression and WW2, and barbiturates access were significantly associated with same year suicide mortality.

DISCUSSION

Contemporaneous alcohol consumption was associated with decreased suicide mortality, but was also associated with an increased risk of suicide 12 years later. Unemployment and barbiturates access were associated with an increased risk of suicide. Interventions and policies that address chronic alcohol consumption and support the unemployed may reduce suicide mortality.

Modelling the impact of increased alcohol taxation on alcohol-attributable cancers in the WHO European Region

BACKGROUND

Reducing the alcohol-attributable cancer burden in the WHO European Region is a public health priority. This study aims to estimate the number of potentially avoidable cancers in countries of the WHO European Region in 2019 for three scenarios in which current excise duties on alcoholic beverages were increased by 20%, 50%, or 100%.

METHODS

Mean prices and excise duties for beer, wine, and spirits in the Member States of the WHO European Region in 2020 were used as the baseline scenario. We assumed that increases in excise duties (20%, 50%, and 100%) were fully incorporated into the consumer price. Beverage-specific price elasticities of demand, with lower elasticities for heavy drinkers, were obtained from a meta-analysis. Model estimates were applied to alcohol exposure data for 2009 and cancer incidence and mortality rates for 2019, assuming a 10-year lag time between alcohol intake and cancer development and mortality.

FINDINGS

Of 180,887 (95% Confidence interval [CI]: 160,595-201,705) new alcohol-attributable cancer cases and 85,130 (95% CI: 74,920-95,523) deaths in the WHO European Region in 2019, 5·9% (95% CI: 5·6-6·4) and 5·7% (95% CI: 5·4-6·1), respectively, could have been avoided by increasing excise duties by 100%. According to our model, alcohol-attributable female breast cancer and colorectal cancer contributed most to the avoidable cases and deaths.

INTERPRETATION

Doubling current alcohol excise duties could avoid just under 6% (or 10,700 cases and 4,850 deaths) of new alcohol-attributable cancers within the WHO European Region, particularly in Member States of the European Union where excise duties are in many cases very low.

FUNDING

None.

Alcohol policy and gender: a modelling study estimating gender-specific effects of alcohol pricing policies

AIMS

To describe gender differences in alcohol consumption, purchasing preferences and alcohol-attributable harm. To model the effects of alcohol pricing policies on male and female consumption and hospitalizations.

DESIGN

Epidemiological simulation using the Sheffield Alcohol Policy Model version 4.

SETTING AND PARTICIPANTS

Adults aged 18+ years, England.

INTERVENTIONS

Three alcohol pricing policies: 10% duty increase and minimum unit prices (MUP) of £0.50 and £0.70 per UK unit.

MEASURES

Gender-specific baseline and key outcomes data: annual beverage-specific units of alcohol consumed and beverage-specific alcohol expenditure (household surveys). Alcohol-attributable hospital admissions (administrative data). Key model parameters: literature-based own- and cross-price elasticities for 10 beverage-by-location categories (e.g. off-trade beer). Sensitivity analysis with new gender-specific elasticities. Literature-based risk functions linking consumption and harm, gender-disaggregated where evidence was available. Population subgroups: 120 subgroups defined by gender (primary focus), age, deprivation quintile and baseline weekly consumption.

FINDINGS

Women consumed 59.7% of their alcohol as off-trade wine while men consumed 49.7% as beer. Women drinkers consumed fewer units annually than men (494 versus 895) and a smaller proportion of women were high-risk drinkers (4.8 versus 7.2%). Moderate drinking women had lower hospital admission rates than men (44 versus 547 per 100 000), but rates were similar for high-risk drinking women and men (14 294 versus 13 167 per 100 000). All three policies led to larger estimated reductions in consumption and admission rates among men than women. For example, a £0.50 MUP led to a 5.3% reduction in consumption and a 4.1% reduction in admissions for men but a 0.7% reduction in consumption and a 1.6% reduction in hospitalizations for women.

CONCLUSION

Alcohol consumption, purchasing preferences and harm show strong gender patterns among adult drinkers in England. Alcohol pricing policies are estimated to be more effective at reducing consumption and harm for men than women.

Тhe impact of alcohol abuse on the development of non-communicable diseases (analytical review)

The harmful use of alcohol is a risk factor for the development of non-communicable diseases (NCDs), such as cancer, cardiovascular disease, gastrointestinal diseases, diabetes and others. In addition to morbidity, alcohol abuse increases mortality, especially at young ages. An important characteristic is the frequency and amount of alcohol consumed by a person. The more often and more a person abuses alcohol, the higher the risk of developing NCDs and the mortality rate. Purpose of the study: analysis of publications of the World Health Organization and scientific publications of foreign researchers on the influence of alcohol on the development of non-communicable diseases.

Materials and research methods. Content analysis of documents of the World Health Organization and foreign studies on the assessment of the impact of alcohol In total, 48 documents of international organizations were analyzed, including the World Health Organization (WHO), the United Nations (UN), the International Agency for Research on Cancer (IARC-IARC) and the World Bank, as well as 211 scientific publications. Of these, 19 documents were selected, which included materials from WHO, UN, IARC and the World Bank on the impact of alcohol abuse on health, and 63 scientific publications on this topic. Selection criterion: the content in the documents of materials that adequately describe the impact of alcohol abuse on health as a risk factor for the development of various diseases.

Results. An analysis of the documents and publications presented revealed a large massif of evidence that the harmful use of alcohol is a causal factor in the development of a number of noncommunicable diseases, an increase in mortality and disability at earlier stages of life, and the development of a link between harmful use of alcohol and a number of mental and behavioral disorders.

Effects of minimum unit pricing for alcohol in South Africa across different drinker groups and wealth quintiles: a modelling study

OBJECTIVES

To quantify the potential impact of minimum unit pricing (MUP) for alcohol on alcohol consumption, spending and health in South Africa. We provide these estimates disaggregated by different drinker groups and wealth quintiles.

DESIGN

We developed an epidemiological policy appraisal model to estimate the effects of MUP across sex, drinker groups (moderate, occasional binge, heavy) and wealth quintiles. Stakeholder interviews and workshops informed model development and ensured policy relevance.

SETTING

South African drinking population aged 15+.

PARTICIPANTS

The population (aged 15+) of South Africa in 2018 stratified by drinking group and wealth quintiles, with a model time horizon of 20 years.

MAIN OUTCOME MEASURES

Change in standard drinks (SDs) (12 g of ethanol) consumed, weekly spend on alcohol, annual number of cases and deaths for five alcohol-related health conditions (HIV, intentional injury, road injury, liver cirrhosis and breast cancer), reported by drinker groups and wealth quintile.

RESULTS

We estimate an MUP of R10 per SD would lead to an immediate reduction in consumption of 4.40% (-0.93 SD/week) and an increase in spend of 18.09%. The absolute reduction is greatest for heavy drinkers (-1.48 SD/week), followed by occasional binge drinkers (-0.41 SD/week) and moderate drinkers (-0.40 SD/week). Over 20 years, we estimate 20 585 fewer deaths and 9 00 332 cases averted across the five health-modelled harms.Poorer drinkers would see greater impacts from the policy (consumption: -7.75% in the poorest quintile, -3.19% in richest quintile). Among the heavy drinkers, 85% of the cases averted and 86% of the lives saved accrue to the bottom three wealth quintiles.

CONCLUSIONS

We estimate that MUP would reduce alcohol consumption in South Africa, improving health outcomes while raising retail and tax revenue. Consumption and harm reductions would be greater in poorer groups.

Alcohol control policies add to secular trends in all-cause mortality rates in young adults

Alcohol consumption is a major risk factor for premature mortality. Although alcohol control policies are known to impact all-cause mortality rates, the effect that policies have on specific age groups is an important area of research. This study investigates the effect of alcohol control policies implemented in 2009 and 2017 in Lithuania on all-cause mortality rates. All-cause mortality rates (deaths per 100,000 people) were obtained for 2001–2018 by 10-year age groups (20–29, 30–39, 40–49 years, etc.). All-cause mortality rates, independent of macro-level secular trends (e.g., economic trends) were examined. Following a joinpoint analysis to control for secular trends, an interrupted time series analysis showed that alcohol control policies had a significant effect on all-cause mortality rates (p = .018), with the most significant impact occurring among young adults (20–29 and 30–39 years of age). For these age groups, their mortality rate decreased during the 12 months following policy implementation (following the policy in 2009 for those 20–29 years of age, p = .0026, and following the policy in 2017 for those 30–39 years of age, p = .011). The results indicate that alcohol control policy can impact all-cause mortality rates, above and beyond secular trends, and that the impact is significant among young adults.

Classifying Alcohol Control Policies with Respect to Expected Changes in Consumption and Alcohol-Attributable Harm: The Example of Lithuania, 2000-2019

Due to the high levels of alcohol use, alcohol-attributable mortality and burden of disease, and detrimental drinking patterns, Lithuania implemented a series of alcohol control policies within a relatively short period of time, between 2008 and 2019. Based on their expected impact on alcohol consumption and alcohol-attributable harm, as well as their target population, these policies have been classified using a set of objective criteria and expert opinion. The classification criteria included: positive vs. negative outcomes, mainly immediate vs. delayed outcomes, and general population vs. specific group outcomes. The judgement of the alcohol policy experts converged on the objective criteria, and, as a result, two tiers of intervention were identified: Tier 1—highly effective general population interventions with an anticipated immediate impact; Tier 2—other interventions aimed at the general population. In addition, interventions directed at specific populations were identified. This adaptable methodological approach to alcohol control policy classification is intended to provide guidance and support for the evaluation of alcohol policies elsewhere, to lay the foundation for the critical assessment of the policies to improve health and increase life expectancy, and to reduce crime and violence.

Potential effects of minimum unit pricing at local authority level on alcohol-attributed harms in North West and North East England: a modelling study

Background

In 2018, Scotland implemented a 50p-per-unit minimum unit price for alcohol. Previous modelling estimated the impact of minimum unit pricing for England, Scotland, Wales and Northern Ireland. Decision-makers want to know the potential effects of minimum unit pricing for local authorities in England; the premise of this study is that estimated effects of minimum unit pricing would vary by locality.

Objective

The objective was to estimate the potential effects on mortality, hospitalisations and crime of the implementation of minimum unit pricing for alcohol at local authority level in England.

Design

This was an evidence synthesis, and used computer modelling using the Sheffield Alcohol Policy Model (local authority version 4.0). This study gathered evidence on local consumption of alcohol from the Health Survey for England, and gathered data on local prices paid from the Living Costs and Food Survey and from market research companies’ actual sales data. These data were linked with local harms in terms of both alcohol-attributable mortality (from the Office for National Statistics) and alcohol-attributable hospitalisations (from Hospital Episode Statistics) for 45 conditions defined by the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. These data were examined for eight age–sex groups split by five Index of Multiple Deprivation quintiles. Alcohol-attributable crime data (Office for National Statistics police-recorded crimes and uplifts for unrecorded offences) were also analysed.

Setting

This study was set in 23 upper-tier local authorities in North West England, 12 upper-tier local authorities in the North East region and nine government office regions, and a national summary was conducted.

Participants

The participants were the population of England aged ≥ 18 years.

Intervention

The intervention was setting a local minimum unit price. The base case is 50p per unit of alcohol. Sensitivity analyses were undertaken using minimum unit prices of 30p, 40p, 60p and 70p per unit of alcohol.

Main outcome measures

The main outcome measures were changes in alcohol-attributable deaths, hospitalisations and crime. Savings in NHS costs, changes in alcohol purchasing and consumption, changes in revenue to off-trade and on-trade retailers and changes in the slope index of inequality between most and least deprived areas were also examined.

Results

The modelling has proved feasible at the upper-tier local authority level. The resulting estimates suggest that minimum unit pricing for alcohol at local authority level could be effective in reducing alcohol-attributable deaths, hospitalisations, NHS costs and crime. A 50p minimum unit price for alcohol at local authority level is estimated to reduce annual alcohol-related deaths in the North West region by 205, hospitalisations by 5956 (–5.5%) and crimes by 8528 (–2.5%). These estimated reductions are mostly due to the 5% of people drinking at high-risk levels (e.g. men drinking > 25 pints of beer or five bottles of wine per week, women drinking > 17 pints of beer or 3.5 bottles of wine per week, and who spend around £2500 per year currently on alcohol). Model estimates of impact are bigger in the North West and North East regions than nationally because, currently, more cheap alcohol is consumed in these regions and because there are more alcohol-related deaths and hospitalisations in these areas. A 30p minimum unit price has estimated effects that are ≈ 90% lower than those of a 50p minimum unit price, and a 40p minimum unit price has estimated effects that are ≈ 50% lower. Health inequalities are estimated to reduce with greater health gains in the deprived areas, where more cheap alcohol is purchased and where there are higher baseline harms.

Limitations

The approach requires synthesis of evidence from multiple sources on alcohol consumption; prices paid; and incidence of diseases, mortality and crime. Price elasticities used are from previous UK analysis of price responsiveness rather than specific to local areas. The study has not estimated ‘cross-border effects’, namely travelling to shops outside the region.

Conclusions

The modelling estimates suggest that minimum unit pricing for alcohol at local authority level would be an effective and well-targeted policy, reducing inequalities.

Future work

The Sheffield Alcohol Policy Model for Local Authorities framework could be further utilised to examine the local impact of national policies (e.g. tax changes) or local policies (e.g. licensing or identification and brief advice). As evidence emerges from the Scottish minimum unit price implementation, this will further inform estimates of impact in English localities. The methods used to estimate drinking and purchasing patterns in each local authority could also be used for other topics involving unhealthy products affecting public health, for example to estimate local smoking or high-fat, high-salt food consumption patterns.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 4. See the NIHR Journals Library website for further project information.

Evaluating the effectiveness of the smartphone app, Drink Less, compared with the NHS alcohol advice webpage, for the reduction of alcohol consumption among hazardous and harmful adult drinkers in the UK at 6-month follow-up: protocol for a randomised controlled trial

BACKGROUND AND AIMS

Digital interventions are effective for reducing alcohol consumption but evidence is limited regarding smartphone apps. Drink Less is a theory- and evidence-informed app to help people reduce their alcohol consumption that has been refined in terms of its content and design for usability across the sociodemographic spectrum. We aim to evaluate the effectiveness and cost-effectiveness of recommending Drink Less at reducing alcohol consumption compared with usual digital care.

DESIGN

Two-arm individually randomised controlled trial.

SETTING

Online trial in the United Kingdom (UK).

PARTICIPANTS

Hazardous or harmful drinkers (Alcohol Use Disorders Identification Test [AUDIT] score ≥8) aged 18+ who want to drink less alcohol (n = 5562). Participants will be recruited from July 2020 to May 2022 using multiple strategies with a focus on remote digital methods.

INTERVENTION AND COMPARATOR

Participants will be randomised to receive either an email recommending that they use Drink Less (intervention) or view the National Health Service (NHS) webpage on alcohol advice (comparator).

MEASUREMENTS

The primary outcome is change in self-reported weekly alcohol consumption, assessed using the extended AUDIT-Consumption, between baseline and 6-month follow-up. Secondary outcomes include change in self-reported weekly alcohol consumption assessed at 1- and 3-month follow-ups, and the proportion of hazardous drinkers; alcohol-related problems and injury; health-related quality of life; and use of health services assessed at 6-month follow-up. Effectiveness will be examined with adjusted regression models, adjusting for baseline alcohol consumption and using an intention-to-treat approach. A mixed-methods process evaluation will assess engagement, acceptability and mechanism of action. Economic evaluations will be conducted using both a short- and longer-term time horizon.

COMMENTS

This study will establish the effectiveness and cost-effectiveness of the Drink Less app at reducing alcohol consumption among hazardous and harmful adult drinkers and will be the first randomised controlled trial of an alcohol reduction app for the general population in the United Kingdom. This study will inform the decision on whether it is worth investing resources in large-scale implementation.

Dimensions of Craving Interact with COMT Genotype to Predict Relapse in Individuals with Alcohol Use Disorder Six Months after Treatment

(1) Background: Alcohol use disorder (AUD) is associated with poor medical, psychological, and psychosocial outcomes and approximately 60% of individuals with AUD relapse six months after treatment. Craving is a core aspect of AUD and associated with high risk of relapse. One promising avenue to improve outcomes may be in understanding the relationship between COMT genotype, craving, and treatment outcomes. (2) Methods: To this end, we assessed craving, recent drinking history, and impulsivity in 70 individuals with AUD undergoing a standard course of treatment at a regional Veteran Affairs (VA) medical center. Saliva samples were collected to determine COMT genotype. In this prospective observational study, participants were followed for six months to determine who went on to relapse after treatment. (3) Results: Results revealed a significant interaction between craving and catechol-O-methyltransferse (COMT) genotype in predicting relapse. Post hoc exploratory analyses indicated that Met/Met homozygotes reported the highest levels of craving, and craving was associated with recent drinking history. Among Val/Val homozygotes, who had higher rates of relapse, craving was associated with impulsivity. (4) Conclusions: These associations highlight that specific profiles of psychological and biological factors may be important in understanding which individuals are at highest risk of relapse following treatment. Future studies that build on these findings are warranted.

Unemployment from stable, downsized and closed workplaces and alcohol-related mortality

AIMS

To assess the importance of health selection in the association between unemployment and alcohol-related mortality by comparing mortalities of those unemployed from workplaces experiencing different levels of downsizing. The more severe the downsizing, the less dependent unemployment would be on personal characteristics and the weaker the role of health selection.

DESIGN

We estimated hazards models of unemployment on alcohol-related diseases and poisonings and external causes with alcohol as a contributing cause over follow-ups of 0-5, 6-10 and 11-20 years and at different levels of downsizing (stable, downsized or closed).

SETTING

Finland, 1990 to 2009.

PARTICIPANTS

A register-based random sample of employees aged 25-63 in privately owned workplaces (n = 275 738).

MEASUREMENTS

The outcome was alcohol-related death and the exposure was unemployment. We adjusted for age, sex, year, education, marital status, health status, workplace tenure, industry, region and unemployment rate.

FINDINGS

Alcohol-disease mortality was elevated among the unemployed throughout the follow-up, regardless of the level of downsizing. At 11-20 years after baseline, those unemployed from stable workplaces had a 2.46 hazard ratio (HR) (95% confidence interval [CI] = 2.14-2.82), those from downsized workplaces 1.94 (95% CI = 1.64-2.30) and those from closed workplaces 2.13 (95% CI = 1.75-2.59), when compared with the controls. Alcohol-related external-cause mortality at 0-5 years follow-up was only associated with unemployment from stable workplaces (HR = 1.39, 95% CI = 1.22-1.58), but over time, an association emerged among those unemployed following downsizing and closure. At 11-20-year follow-up, the HR following downsizing was 1.83 (CI 95% = 1.37-2.45) and 1.54 (95% CI = 1.03-2.28) following closure.

CONCLUSIONS

There is some indication that alcohol-related ill-health may lead to unemployment in Finland. However, the persistent long-term association between unemployment and alcohol-related mortality even after workplace closure may imply a causal relation.

Assessing the contribution of alcohol-specific causes to socio-economic inequalities in mortality in England and Wales 2001-16

BACKGROUND AND AIMS

When measuring inequalities in health, public health and addiction research has tended to focus on differences in average life-span between socio-economic groups. This does not account for the extent to which age of death varies between individuals within socio-economic groups or whether this variation differs between groups. This study assesses (1) socio-economic inequalities in both average life-span and variation in age at death, (2) the extent to which these inequalities can be attributed to alcohol-specific causes (i.e. those attributable only to alcohol) and (3) how this contribution has changed over time.

DESIGN

Cause-deleted life table analysis of national mortality records.

SETTING

England and Wales, 2001-16.

CASES

All-cause and alcohol-specific deaths for all adults aged 18+, stratified by sex, age and quintiles of the index of multiple deprivation (IMD).

MEASUREMENTS

Life expectancy at age 18 yearss and standard deviation in age at death within IMD quintiles and the contribution of alcohol to overall differences in both measures between the highest and lowest IMD quintiles by comparing observed and cause-deleted inequality 'gaps'.

FINDINGS

In 2016, alcohol-specific causes reduced life expectancy for men and women by 0.26 and 0.14 years, respectively, and increased the standard deviation in age at death. These causes also increased the inequality gap in life expectancy by 0.33 years for men and 0.17 years for women, and variation in age at death by 0.14 years and 0.13 years, respectively. For both measures, the contribution of alcohol to mortality inequalities rose after 2001 and subsequently fell back. For women, alcohol accounted for 3.6% of inequality in age at death and 6.0% of life-span uncertainty, suggesting that using only the former may underestimate alcohol-induced inequalities. There was no comparable difference for men.

CONCLUSIONS

Deaths from alcohol-specific causes increase inequalities in both life expectancy and variation in age of death between socio-economic groups. Using both measures can provide a fuller picture of overall inequalities in health.

Alcohol consumption. A leading risk factor for cancer

In 2016, alcohol consumption was one of the leading risk factors for cancer development and cancer death globally, causing an estimated 376 200 cancer deaths, representing 4.2% of all cancer deaths, and 10.3 million cancer disability-adjusted life years lost, representing 4.2% of all cancer disability-adjusted life years lost. The impact of alcohol consumption on cancer in 2016 varied by age group; the proportion of cancer deaths attributable to alcohol consumption ranged from 13.9% of cancer deaths among people aged 30-34 years to 2.7% of cancer deaths among people aged 80-84 years. The burden of cancers caused by alcohol consumption might be decreased through (i) individual-level and societal-level interventions that reduce alcohol consumption, and (ii) measures that target those risk factors that interact with alcohol consumption to increase the risk of cancer or that directly affect the risk of alcohol-related cancers.

The potential global gains in health and revenue from increased taxation of tobacco, alcohol and sugar-sweetened beverages: a modelling analysis

Introduction

Globally, a growing burden of morbidity and mortality is attributable to lifestyle behaviours, and in particular to the consumption of tobacco, alcohol and sugar-sweetened beverages (SSB). In low-income and middle-income countries, this increased disease burden falls on already encumbered and resource-constrained healthcare systems. Fiscal policies, specifically taxation, can lower consumption of tobacco, alcohol and SSB while raising government revenues.

Methods

We simulated the health and economic effects of taxing cigarettes, alcohol and SSB over 50 years for 30-79 years old populations using separate mathematical models for each commodity that incorporated country-level epidemiological, demographic and consumption data. Based on data availability, national-level health effects of higher tobacco, alcohol and SSB taxes were simulated in 141, 166 and 176 countries, respectively, which represented 92%, 97% and 95% of the global population, respectively. Economic effects for tobacco, alcohol and SSB were estimated for countries representing 91%, 43% and 83% of the global population, respectively. These estimates were extrapolated to the global level by matching countries according to income level.

Results

Over 50 years, taxes that raise the retail price of tobacco, alcoholic beverages and SSB by 20% could result in a global gain of 160.7 million (95% uncertainty interval (UI): 96.3 to 225.2 million), 227.4 million (UI: 161.2 to 293.6 million) and 24.3 million (UI: 15.7 to 35.4 million) additional life years, respectively.

Conclusion

Excise tax increases on tobacco, alcohol and SSB can produce substantial health gains by reducing premature mortality while raising government revenues, which could be used to increase public health funding.

Expanding attributable fraction applications to outcomes wholly attributable to a risk factor

The problem central to this document is the estimation of change in disease attributable to an epidemiological exposure variable that stems from a change in the distribution of that variable. We require that both disease and exposure are quantifiable as real numbers, and then ask how to estimate the fraction of disease attributable to exposure, producing the general attributable fraction methodology. After the mathematical framework is in place, we explore the implications of a disease that is wholly attributable to a given risk factor, demonstrate why standard applications of the attributable fractions do not extend, and present general methodological considerations for this case. Finally, we demonstrate the methodology using the example of alcoholic psychoses.

[Provision of healthcare for people with risky alcohol use and severe alcohol use disorders in the state of Bremen, Germany: demand and guideline concordance?]

BACKGROUND

Early detection of risky alcohol use and severe alcohol use disorders (AUDs) is crucial to avoid adverse health consequences. The German "Guidelines on Screening, Diagnosis and Treatment of Alcohol Use Disorders" recommend to routinely screen patients for hazardous alcohol use and to subsequently conduct brief interventions, for example in primary healthcare. For severe AUDs, provision of withdrawal treatment is recommended in inpatient settings if complications are anticipated.

OBJECTIVES

To estimate the proportion of people with hazardous alcohol use or severe AUDs receiving healthcare as stipulated by the guidelines.

MATERIALS AND METHODS

The prevalence of hazardous use (female ≥12 g; male ≥24 g) and severe AUDs (female ≥60 g; male ≥90 g) was estimated using per capita consumption of pure alcohol. Treatment rates were estimated using survey data (for hazardous use) and inpatient admissions (for severe AUDs). All estimates refer to the adult population (15 years or older) of the federal state of Bremen for 2016.

RESULTS

Physicians screened 2.9% of all people with hazardous alcohol use and conducted brief interventions with 1.4%. Among people with severe AUDs, 7.1% received inpatient treatment. Among people with severe AUDs who required inpatient treatment, 14.1% received withdrawal treatment in inpatient settings. Treatment rates below average were registered among 21- to 39-year-olds.

CONCLUSIONS

In Bremen, provision of guideline-conform healthcare for hazardous alcohol use and severe AUDs is insufficient, especially among 21- to 39-year-olds.

The effects of alcohol pricing policies on consumption, health, social and economic outcomes, and health inequality in Australia: a protocol of an epidemiological modelling study

INTRODUCTION

Alcohol use and misuse are associated with substantial health and social issues in Australia and internationally. Pricing policy is considered as one of the most effective means to reduce risky drinking and related harms. This protocol paper describes a study that will model and estimate the effects, effectiveness and cost-benefit of alcohol pricing policy initiatives in reducing risky drinking, health and social harms, and health inequalities among subpopulations in Australia.

METHODS AND ANALYSIS

The study is a modelling and epidemiological study using data from various resources, such as survey, previous literatures and response agencies. A number of statistical procedures will be undertaken to evaluate the impact of different alcohol pricing policy initiatives on various outcomes, including alcohol consumption in population subgroups, and health and social problems, and to measure health inequalities and cost-effectiveness of those proposed pricing policies, such as a 10% tax increase on all alcohol beverages or introduction of a minimum unit price.

ETHICS AND DISSEMINATION

The ethics approval of this study was obtained from the College Human Ethics Sub-Committee of the La Trobe University on 9 November 2017 (Ref: S17-206). While examining the heterogeneous effects of price policy across population subgroups, this study will provide the first comprehensive estimates of the likely impacts of alcohol price changes on health inequalities. The study will also provide sophisticated economic analyses of the impact of price policy changes, which is critical information for policy makers and will assist policy makers in directing resources to a more efficient alcohol strategy. Results will be made available to communities and societies, health departments and other researchers.

Research Protocol to Evaluate the Effects of Alcohol Policy Changes in Lithuania

Aims

To point out the importance for public health to evaluate the past policy changes (2016-2018) in Lithuania. To present a research protocol to conduct this evaluation.

Short summary

The staggered implementation of key alcohol policies in Lithuania over the past two years offers the possibility to evaluate 'best buys' for alcohol policies for this country. Lithuania is the only country where all 'best buys' were implemented over a short period of time, so this evaluation will be unique.

Methods

Quasi-experimental design based on interrupted time-series analysis of monthly routine statistics of morbidity and mortality indicators as well as key variables on the pathway between alcohol exposure and health outcomes.

Conclusions

For the public health community, results of the evaluation of these policy changes will be of critical importance.

New Estimates of the Mean Ethanol Content of Beer, Wine, and Spirits Sold in the United States Show a Greater Increase in Per Capita Alcohol Consumption than Previous Estimates

BACKGROUND

Recent increases in alcohol-related morbidity and mortality have not occurred alongside notable increases in per capita alcohol consumption (PCC). This discrepancy may be partially due to U.S. PCC estimates not including annual estimates of the percentage of alcohol by volume (%ABV) of beer, wine, and spirits, but rather relying on time-invariant %ABV values.

METHODS

Building on a prior study covering 1950 to 2002, estimates of the annual mean %ABV of beer, wine, and spirits sold in the United States were calculated using the %ABV of major brands and sales of each beverage type for each state and nationally for the period 2003 to 2016. We applied these estimates to the calculation of annual beverage-specific and total PCC, and made descriptive comparisons between our PCC estimates and those estimates using invariant %ABV values.

RESULTS

For all beverage types, our mean %ABV estimates increased nationally and for all but 5 states. The PCC estimates from wine and spirits utilizing variable %ABV values were lower than estimates using invariant %ABV, and consumption from beer was higher. Our total PCC estimates were also lower than %ABV-invariant estimates; however, the percent change for %ABV-invariant estimates was 5.8% compared to a 7.9% change in our %ABV-variant estimates over the 2003 to 2016 period.

CONCLUSIONS

Given the application of PCC estimates to understand changes in alcohol-related morbidity and mortality, the inclusion of annual estimates of the %ABV of alcoholic beverages sold in the United States is necessary to ensure the precision of PCC measures such that the conclusions drawn from these applications are accurate and valid.

Temporal Associations of Alcohol and Tobacco Consumption With Cancer Mortality

IMPORTANCE

Understanding whether the population-level consumption of alcohol and tobacco is associated with cancer mortality is a crucial question for public health policy that has not been answered by previous studies.

OBJECTIVE

To examine temporal associations of alcohol and tobacco consumption with overall cancer mortality in the Australian population, looking across different sex and age groups.

DESIGN, SETTING, AND PARTICIPANTS

This population-based cohort study conducted a time series analysis (autoregressive integrated moving average models) using aggregate-level annual time series data from multiple sources. Data on alcohol consumption and tobacco consumption per capita between 1935 and 2014 among the Australian population aged 15 years and older were collected from the Australian Bureau of Statistics and Cancer Council Victoria. Analysis was conducted from June 1, 2017, to October 30, 2017.

EXPOSURES

Sex- and age-specific cancer mortality rates from 1968 to 2014 were collected from the Australian Institute Health and Welfare.

MAIN OUTCOMES AND MEASURES

Population-level cancer mortality in different sex and age groups in Australia, controlling for the effects of health expenditure.

RESULTS

Among the Australian total population aged 15 years and older in this study, 50.5% were women. Cancer death rates per 100 000 persons increased from 199 in 1968 to 214 in 1989 and then decreased steadily to 162 in 2014. Taking into account lagged effects, 1-L decreases in alcohol consumption per capita were associated with a decline of 3.9% in overall cancer mortality over a 20-year period, and 1-kg decreases in tobacco consumption per capita were associated with a 16% reduction. Alcohol consumption per capita was significantly associated with overall cancer mortality among men aged 50 to 69 years and women aged 50 years and older. Tobacco consumption per capita was found to be significantly associated with overall cancer mortality only among men aged 50 years and older.

CONCLUSIONS AND RELEVANCE

In this study, alcohol consumption per capita was positively associated with overall cancer mortality among older men and women, and tobacco consumption per capita was positively associated with overall cancer mortality among older men over a 20-year period. This study provides evidence that a decrease in population-level drinking and tobacco smoking could lead to a reduction in cancer mortality.

Alcohol dependence and very high risk level of alcohol consumption: a life-threatening and debilitating disease

Women and men with alcohol dependence and very high risk drinking level (VHRDL; defined as drinking >60 or 100 g of ethanol per day, respectively) experience severe health consequences; however, data on the number of these individuals and their health risks are limited. This study estimated (1) the prevalence of VHRDL in 13 European Union (EU) countries among people 15-65 years of age, (2) the risk of disease and injury occurrence associated with VHRDL, (3) the proportion of deaths in nine EU countries attributable to VHRDL and (4) the life expectancy of people in France with VHRDL. Prevalence estimates of VHRDL were based on data obtained from clinical trials and the Global Information System on Alcohol and Health. The risk of disease and injury occurrence was estimated using microsimulations. Population-attributable fractions (PAFs) were estimated using a Levin-based methodology. The estimated prevalence of VHRDL in the 13 EU countries examined was 0.74-0.85 percent, with a disease and injury occurrence risk of 13.5 per 100 people with VHRDL per year. For the nine EU countries examined, VHRDL caused 53.6 percent of all liver cirrhosis, 43.8 percent of all pancreatitis and 41.1 percent of oral cavity and pharyngeal cancers (all other PAFs were below 30 percent). Applying these PAFs to French mortality data resulted in a life expectancy of 47-61 years for people with VHRDL-21-35 years less than the general population. These results indicate that the health burdens of VHRDL are potentially large, and interventions targeting VHRDL should be considered when formulating public health policies.

The short-term impact of the alcohol act on alcohol-related deaths and hospital admissions in Scotland: a natural experiment

BACKGROUND AND AIM

The introduction of the Alcohol Act in Scotland on 1 October 2011, which included a ban on multi-buy promotions, was probably associated with a fall in off-trade alcohol sales in the year after its implementation. The aim of this study was to test if the same legislation was associated with reduced levels of alcohol-related deaths and hospital admissions in the 3-year period after its introduction.

DESIGN

A natural experiment design using time-series data to assess the impact of the Alcohol Act legislation in Scotland. Comparisons were made with unexposed populations in the rest of Great Britain.

SETTING

Scotland with comparable data obtained for geographical control groups in other parts of Great Britain.

PARTICIPANTS

For alcohol-related deaths, a total of 17 732 in Scotland and 88 001 in England and Wales throughout 169 4-week periods between January 2001 and December 2013 and for alcohol-related hospital admissions, a total of 121 314 in Scotland and 696 892 in England throughout 182 4-week periods between January 2001 and December 2014.

MEASUREMENTS

Deaths and hospital admissions in Scotland and control groups that were wholly attributable to alcohol for consecutive 4-week periods between January 2001 and December 2014. Data were obtained by age, sex and area-based socio-economic position.

FINDINGS

There was no evidence to suggest that the Alcohol Act was associated with changes in the overall rate of alcohol-related deaths [incidence rate ratio (IRR) = 0.99, 95% confidence interval (CI) = 0.91-1.07)] or hospital admissions (IRR = 0.98, 95% CI = 0.95-1.02) in Scotland. In control group analyses, the pseudo intervention variable was not associated with a change in alcohol-related death rates in England/Wales (IRR = 0.99, 95% CI = 0.95-1.02), but was associated with an increase in alcohol-related hospital admission rates in England (IRR = 1.05, 95% CI = 1.03-1.07). In combined models, the interaction analysis did not provide support for a 'net effect' of the legislation on alcohol-related deaths in Scotland compared with England/Wales (IRR 0.99, 95% CI = 0.95-1.04), but suggested a net reduction in hospital admissions for Scotland compared with England (IRR = 0.93, 95% CI = 0.87-0.98).

CONCLUSION

The implementation of the Alcohol Act in Scotland has not been associated clearly with a reduction in alcohol-related deaths or hospital admissions in the 3-year period after it was implemented in October 2011.

The impact of alcohol policies on alcohol-attributable diseases in Taiwan-A population-based study

BACKGROUND

Taiwan has some of the strictest alcohol-related driving laws in the world. However, its laws continue to be toughened to reduce the ever-increasing social cost of alcohol-related harm.

AIM

This study assumes that alcohol-related driving laws show a spillover effect such that behavioral changes originally meant to apply behind the wheel come to affect drinking behavior in other contexts. The effects of alcohol driving laws and taxes on alcohol-related morbidity are assessed; incidence rates of alcohol-attributable diseases (AAD) serve as our measure of morbidity.

METHODS

Monthly incidence rates of alcohol-attributable diseases were calculated with data from the National Health Insurance Research Database (NHIRD) from 1996 to 2011. These rates were then submitted to intervention analyses using Seasonal Autoregressive Integrated Moving Average models (ARIMA) with multivariate adaptive regression splines (MARS). ARIMA is well-suited to time series analysis while MARS helps fit the regression model to the cubic curvature form of the irregular AAD incidence rates of hospitalization (AIRH).

RESULTS

Alcoholic liver disease, alcohol abuse and dependence syndrome, and alcohol psychoses were the most common AADs in Taiwan. Compared to women, men had a higher incidence of AADs and their AIRH were more responsive to changes in the laws governing permissible blood alcohol. The adoption of tougher blood alcohol content (BAC) laws had significant effects on AADs, controlling for overall consumption of alcoholic beverages.

CONCLUSION

Blood alcohol level laws and alcohol taxation effectively reduced alcohol-attributable morbidities with the exception of alcohol dependence and abuse, a disease to which middle-aged, lower income people are particularly susceptible. Attention should be focused on this cohort to protect this vulnerable population.

Towards new recommendations to reduce the burden of alcohol-induced hypertension in the European Union

BACKGROUND

Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets.

METHODS

A consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statistical modelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded.

RESULTS

Screening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries.

CONCLUSIONS

The implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation.

Is there an association between trends in alcohol consumption and cancer mortality? Findings from a multicountry analysis

The aim of this analysis is to examine long-term trends in alcohol consumption and associations with lagged data on specific types of cancer mortality, and indicate policy implications. Data on per capita annual sales of pure alcohol; mortality for three alcohol-related cancers - larynx, esophageal, and lip, oral cavity, and pharynx; and per capita consumption of tobacco products were extracted at the country level. The Unobservable Components Model was used for this time-series analysis to examine the temporal association between alcohol consumption and cancer mortality, using lagged data, from 17 countries. Statistically significant associations were observed between alcohol sales and cancer mortality, in the majority of countries examined, which remained after controlling for tobacco use (P<0.05). Significant associations were observed in countries with increasing, decreasing, or stable trends in alcohol consumption and corresponding lagged trends in alcohol-related cancer mortality. Curtailing overall consumption has potential benefits in reducing a number of harms from alcohol, including cancer mortality. Future research and surveillance are needed to investigate, monitor, and quantify the impact of alcohol control policies on trends in cancer mortality.

The intervention effect of local alcohol licensing policies on hospital admission and crime: a natural experiment using a novel Bayesian synthetictime-series method

Background

Control of alcohol licensing at local government level is a key component of alcohol policy in England. There is, however, only weak evidence of any public health improvement. We used a novel natural experiment design to estimate the impact of new local alcohol licensing policies on hospital admissions and crime.

Methods

We used Home Office licensing data (2007–2012) to identify (1) interventions: local areas where both a cumulative impact zone and increased licensing enforcement were introduced in 2011; and (2) controls: local areas with neither. Outcomes were 2009–2015 alcohol-related hospital admissions, violent and sexual crimes, and antisocial behaviour. Bayesian structural time series were used to create postintervention synthetic time series (counterfactuals) based on weighted time series in control areas. Intervention effects were calculated from differences between measured and expected trends. Validation analyses were conducted using randomly selected controls.

Results

5 intervention and 86 control areas were identified. Intervention was associated with an average reduction in alcohol-related hospital admissions of 6.3% (95% credible intervals (CI) −12.8% to 0.2%) and to lesser extent with a reduced in violent crimes, especially up to 2013 (–4.6%, 95% CI −10.7% to 1.4%). There was weak evidence of an effect on sexual crimes up 2013 (–8.4%, 95% CI −21.4% to 4.6%) and insufficient evidence of an effect on antisocial behaviour as a result of a change in reporting.

Conclusion

Moderate reductions in alcohol-related hospital admissions and violent and sexual crimes were associated with introduction of local alcohol licensing policies. This novel methodology holds promise for use in other natural experiments in public health.

The relationship between different dimensions of alcohol use and the burden of disease-an update

BACKGROUND AND AIMS

Alcohol use is a major contributor to injuries, mortality and the burden of disease. This review updates knowledge on risk relations between dimensions of alcohol use and health outcomes to be used in global and national Comparative Risk Assessments (CRAs).

METHODS

Systematic review of reviews and meta-analyses on alcohol consumption and health outcomes attributable to alcohol use. For dimensions of exposure: volume of alcohol use, blood alcohol concentration and patterns of drinking, in particular heavy drinking occasions were studied. For liver cirrhosis, quality of alcohol was additionally considered. For all outcomes (mortality and/or morbidity): cause of death and disease/injury categories based on International Classification of Diseases (ICD) codes used in global CRAs; harm to others.

RESULTS

In total, 255 reviews and meta-analyses were identified. Alcohol use was found to be linked causally to many disease and injury categories, with more than 40 ICD-10 three-digit categories being fully attributable to alcohol. Most partially attributable disease categories showed monotonic relationships with volume of alcohol use: the more alcohol consumed, the higher the risk of disease or death. Exceptions were ischaemic diseases and diabetes, with curvilinear relationships, and with beneficial effects of light to moderate drinking in people without heavy irregular drinking occasions. Biological pathways suggest an impact of heavy drinking occasions on additional diseases; however, the lack of medical epidemiological studies measuring this dimension of alcohol use precluded an in-depth analysis. For injuries, except suicide, blood alcohol concentration was the most important dimension of alcohol use. Alcohol use caused marked harm to others, which has not yet been researched sufficiently.

CONCLUSIONS

Research since 2010 confirms the importance of alcohol use as a risk factor for disease and injuries; for some health outcomes, more than one dimension of use needs to be considered. Epidemiological studies should include measurement of heavy drinking occasions in line with biological knowledge.

Alcohol-attributable cancer deaths under 80 years of age in New Zealand

INTRODUCTION AND AIMS

Cancer deaths made up 30% of all alcohol-attributable deaths in New Zealanders aged 15-79 years in 2007, more than all other chronic diseases combined. We aimed to estimate alcohol-attributable cancer mortality and years of life lost by cancer site and identify differences between Māori and non-Māori New Zealanders.

DESIGN AND METHODS

We applied the World Health Organization's comparative risk assessment methodology at the level of Māori and non-Māori subpopulations. Proportions of specific alcohol-related cancers attributable to alcohol were calculated by combining alcohol consumption estimates from representative surveys with relative risks from recent meta-analyses. These proportions were applied to both 2007 and 2012 mortality data.

RESULTS

Alcohol consumption was responsible for 4.2% of all cancer deaths under 80 years of age in 2007. An average of 10.4 years of life was lost per person; 12.7 years for Māori and 10.1 years for non-Māori. Half of the deaths were attributable to average consumption of <4 standard drinks per day. Breast cancer comprised 61% of alcohol-attributable cancer deaths in women, and more than one-third of breast cancer deaths were attributable to average consumption of <2 standard drinks per day. Mortality data from 2012 produced very similar findings.

DISCUSSION AND CONCLUSIONS

Alcohol is an important and modifiable cause of cancer. Risk of cancer increases with higher alcohol consumption, but there is no safe level of drinking. Reduction in population alcohol consumption would reduce cancer deaths. Additional strategies to reduce ethnic disparities in risk and outcome are needed in New Zealand. [Connor J, Kydd R, Maclennan B, Shield K, Rehm J. Alcohol-attributable cancer deaths under 80 years of age in New Zealand. Drug Alcohol Rev 2017;36:415-423].

The relationship between different dimensions of alcohol use and the burden of disease-an update

BACKGROUND AND AIMS

Alcohol use is a major contributor to injuries, mortality and the burden of disease. This review updates knowledge on risk relations between dimensions of alcohol use and health outcomes to be used in global and national Comparative Risk Assessments (CRAs).

METHODS

Systematic review of reviews and meta-analyses on alcohol consumption and health outcomes attributable to alcohol use. For dimensions of exposure: volume of alcohol use, blood alcohol concentration and patterns of drinking, in particular heavy drinking occasions were studied. For liver cirrhosis, quality of alcohol was additionally considered. For all outcomes (mortality and/or morbidity): cause of death and disease/injury categories based on International Classification of Diseases (ICD) codes used in global CRAs; harm to others.

RESULTS

In total, 255 reviews and meta-analyses were identified. Alcohol use was found to be linked causally to many disease and injury categories, with more than 40 ICD-10 three-digit categories being fully attributable to alcohol. Most partially attributable disease categories showed monotonic relationships with volume of alcohol use: the more alcohol consumed, the higher the risk of disease or death. Exceptions were ischaemic diseases and diabetes, with curvilinear relationships, and with beneficial effects of light to moderate drinking in people without heavy irregular drinking occasions. Biological pathways suggest an impact of heavy drinking occasions on additional diseases; however, the lack of medical epidemiological studies measuring this dimension of alcohol use precluded an in-depth analysis. For injuries, except suicide, blood alcohol concentration was the most important dimension of alcohol use. Alcohol use caused marked harm to others, which has not yet been researched sufficiently.

CONCLUSIONS

Research since 2010 confirms the importance of alcohol use as a risk factor for disease and injuries; for some health outcomes, more than one dimension of use needs to be considered. Epidemiological studies should include measurement of heavy drinking occasions in line with biological knowledge.

Noncommunicable Diseases: Three Decades Of Global Data Show A Mixture Of Increases And Decreases In Mortality Rates

Noncommunicable diseases are the leading health concerns of the modern era, accounting for two-thirds of global deaths, half of all disability, and rapidly growing costs. To provide a contemporary overview of the burdens caused by noncommunicable diseases, we compiled mortality data reported by authorities in forty-nine countries for atherosclerotic cardiovascular diseases; diabetes; chronic respiratory diseases; and lung, colon, breast, cervical, liver, and stomach cancers. From 1980 to 2012, on average across all countries, mortality for cardiovascular disease, stomach cancer, and cervical cancer declined, while mortality for diabetes, liver cancer, and female chronic respiratory disease and lung cancer increased. In contrast to the relatively steep cardiovascular and cancer mortality declines observed in high-income countries, mortality for cardiovascular disease and chronic respiratory disease was flat in most low- and middle-income countries, which also experienced increasing breast and colon cancer mortality. These divergent mortality patterns likely reflect differences in timing and magnitude of risk exposures, health care, and policies to counteract the diseases. Improving both the coverage and the accuracy of mortality documentation in populous low- and middle-income countries is a priority, as is the need to rigorously evaluate societal-level interventions. Furthermore, given the complex, chronic, and progressive nature of noncommunicable diseases, policies and programs to prevent and control them need to be multifaceted and long-term, as returns on investment accrue with time.

A narrative review of alcohol consumption as a risk factor for global burden of disease

Since the original Comparative Risk Assessment (CRA) for alcohol consumption as part of the Global Burden of Disease Study for 1990, there had been regular updates of CRAs for alcohol from the World Health Organization and/or the Institute for Health Metrics and Evaluation. These studies have become more and more refined with respect to establishing causality between dimensions of alcohol consumption and different disease and mortality (cause of death) outcomes, refining risk relations, and improving the methodology for estimating exposure and alcohol-attributable burden. The present review will give an overview on the main results of the CRAs with respect to alcohol consumption as a risk factor, sketch out new trends and developments, and draw implications for future research and policy.

A microsimulation cost-utility analysis of alcohol screening and brief intervention to reduce heavy alcohol consumption in Canada

BACKGROUND AND AIMS

Screening and brief intervention (SBI) is a public health intervention that has been shown to be effective in reducing heavy alcohol consumption. The aim of this study is to estimate the cost-effectiveness of implementing universal alcohol SBI in primary care in Canada.

DESIGN

We developed a microsimulation model of alcohol consumption and its effects on 18 alcohol-related causes of death.

SETTING

The model simulates a Canadian population.

PARTICIPANTS

The model simulates individuals and their alcohol consumption on a continuous scale starting from age 17 years to death.

INTERVENTIONS

The reference case assumes no SBI in Canada. The base case assumes screening was conducted using the Alcohol Use Disorders Identification Test (AUDIT) at a threshold score of 8. Additional analyses included evaluating SBI using the AUDIT at threshold scores between 4 and 8 or the Derived Alcohol Use Disorders Identification Test (AUDIT-C) at threshold scores between 3 and 7.

MEASUREMENTS

The model estimates the direct health-care costs, life years gained and quality-adjusted life years (QALY) gained, which are then used to estimate the incremental cost-effectiveness ratio (ICER) of SBI versus no SBI.

FINDINGS

SBI with AUDIT (at a threshold score of 8) had an ICER of $8729/QALY. Our results suggest that using AUDIT thresholds between 8 and 4, inclusive, would be cost-effective for the whole population, as well as for men and women individually. Our results suggest that the AUDIT-C would be cost-effective at thresholds of 7 to 3, inclusive, for men, women and the whole population.

CONCLUSIONS

In Canada, screening and brief intervention via Alcohol Use Disorders Identification Test (AUDIT) and Derived Alcohol Use Disorders Identification Test (AUDIT-C) to reduce heavy alcohol consumption appears to be cost-effective for men and women at Alcohol Use Disorders Identification Test (AUDIT) thresholds of 8 and lower and at Derived Alcohol Use Disorders Identification Test (AUDIT-C) thresholds of 7 and lower.

Preference weights for the spectrum of alcohol use in the U.S. Population

BACKGROUND

Little is known about the cost-utility of population-based alcohol interventions. One barrier to research has been the lack of preference weights needed to calculate Quality Adjusted Life Years (QALYs). Preference weights can be estimated from measures of health-related quality of life (HRQOL). The objective of this study was to describe preference weights for the full spectrum of alcohol use.

METHODS

This cross-sectional study included participants in both the National Health Interview Survey (NHIS; 1999-2002) and the Medical Expenditure Panel Survey (MEPS; 2000-2003). The AUDIT-C alcohol screen was derived from NHIS with scores categorized into 6 groups (0,1-3, 4-5, 6-7, 8-9, 10-12 points), ranging from nondrinking (0) to very severe unhealthy alcohol use (10-12). AUDIT-C scores were mapped to EQ-5D and SF-6D preference weights using the linked datasets and analyses adjusted for demographics.

RESULTS

Among 17,440 participants, mean EQ-5D and SF-6D preference weights were 0.82 (95% CI 0.82-0.83) and 0.79 (95% CI 0.79-0.80), respectively. Adjusted EQ-5D preference weights for nondrinking (0.80; 95% CI 0.79-0.81) and moderate unhealthy drinking (0.85; 95% CI 0.84-0.86) were significantly different from low-risk drinking (0.83; 95% CI 0.83-0.84), but no other differences were significant. Results for the SF-6D were similar.

CONCLUSIONS

This study provides EQ-5D and SF-6D preference weights for various alcohol use categories in a representative U.S. adult sample. However, neither measure suggested meaningful differences in HRQOL based on AUDIT-C categories. Self-reported alcohol consumption may not be associated with preference weights or generic instruments may not capture alcohol-related differences in HRQOL.