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Rehm J, Badaras R, Ferreira-Borges C, Galkus L, Gostautaite Midttun N, Gobiņa I, Janik-Koncewicz K, Jasilionis D, Jiang H, Kim KV, Lange S, Liutkutė-Gumarov V, Manthey J, Miščikienė L, Neufeld M, Petkevičienė J, Radišauskas R, Reile R, Room R, Stoppel R, Tamutienė I, Tran A, Trišauskė J, Zatoński M, Zatoński WA, Zurlytė I, Štelemėkas M. Impact of the WHO "best buys" for alcohol policy on consumption and health in the Baltic countries and Poland 2000-2020. THE LANCET REGIONAL HEALTH. EUROPE 2023; 33:100704. [PMID: 37953993 PMCID: PMC10636269 DOI: 10.1016/j.lanepe.2023.100704] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 11/12/2023]
Abstract
Alcohol use is a major risk factor for burden of disease. This narrative review aims to document the effects of major alcohol control policies, in particular taxation increases and availability restrictions in the three Baltic countries (Estonia, Latvia, and Lithuania) between 2000 and 2020. These measures have been successful in curbing alcohol sales, in general without increasing consumption of alcoholic beverages from unrecorded sources; although for more recent changes this may have been partly due to the COVID-19 pandemic. Moreover, findings from time-series analyses suggest improved health, measured as reductions in all-cause and alcohol-attributable mortality, as well as narrowing absolute mortality inequalities between lower and higher educated groups. For most outcomes, there were sex differences observed, with alcohol control policies more strongly affecting males. In contrast to this successful path, alcohol control policies were mostly dismantled in the neighbouring country of Poland, resulting in a rising death toll due to liver cirrhosis and other alcohol-attributable deaths. The natural experiment in this region of high-income European countries with high consumption levels highlights the importance of effective alcohol control policies for improving population health.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario M5S 2S1, Canada
- World Health Organization/Pan American Health Organization Collaborating Centre, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario M5S 2S1, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada
- Faculty of Medicine, Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, Hamburg 20246, Germany
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8, Canada
- Institute of Medical Science, University of Toronto, Medical Sciences Building, 1 King’s College Circle, Room 2374, Toronto, Ontario M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada
- Program on Substance Abuse & WHO CC, Public Health Agency of Catalonia, 81-95 Roc Boronat St., Barcelona 08005, Spain
| | - Robertas Badaras
- Faculty of Medicine, Clinic of Anaesthesiology and Intensive Care, Centre of Toxicology, Vilnius University, M. K. Čiurlionio g. 21, Vilnius LT-03101, Lithuania
| | - Carina Ferreira-Borges
- World Health Organization, Regional Office for Europe, UN City, Marmorvej 5, Copenhagen DK-2100, Denmark
| | - Lukas Galkus
- Faculty of Public Health, Health Research Institute, Lithuanian University of Health Sciences, Tilzes Str. 18, Kaunas 47181, Lithuania
| | - Nijole Gostautaite Midttun
- Lithuanian Tobacco and Alcohol Control Coalition, Stikliu 8, Vilnius 01131, Lithuania
- Mental Health Initiative, Teatro 3-10, Vilnius 03107, Lithuania
| | - Inese Gobiņa
- Department of Public Health and Epidemiology, Riga Stradiņš University, Kronvalda Boulevard 9, Riga LV-1010, Latvia
- Institute of Public Health, Riga Stradiņš University, Kronvalda Boulevard 9, Riga LV-1010, Latvia
| | - Kinga Janik-Koncewicz
- Institute – European Observatory of Health Inequalities, Calisia University, Nowy Swiat 4, Kalisz 62-800, Poland
- Health Promotion Foundation, Mszczonowska 51, Nadarzyn 05-830, Poland
| | - Domantas Jasilionis
- Max Planck Institute for Demographic Research, Laboratory of Demographic Data, Konrad-Zuse-Str. 1, Rostock 18057, Germany
- Vytautas Magnus University, Demographic Research Centre, Jonavos g. 66, Kaunas 44191, Lithuania
| | - Huan Jiang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8, Canada
| | - Kawon Victoria Kim
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario M5S 2S1, Canada
| | - Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario M5S 2S1, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada
- Institute of Medical Science, University of Toronto, Medical Sciences Building, 1 King’s College Circle, Room 2374, Toronto, Ontario M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada
| | - Vaida Liutkutė-Gumarov
- Faculty of Public Health, Health Research Institute, Lithuanian University of Health Sciences, Tilzes Str. 18, Kaunas 47181, Lithuania
| | - Jakob Manthey
- Faculty of Medicine, Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, Hamburg 20246, Germany
- Medical Faculty, Department of Psychiatry, University of Leipzig, Semmelweisstraße 10, Leipzig 04103, Germany
| | - Laura Miščikienė
- Faculty of Public Health, Health Research Institute, Lithuanian University of Health Sciences, Tilzes Str. 18, Kaunas 47181, Lithuania
| | - Maria Neufeld
- World Health Organization, Regional Office for Europe, UN City, Marmorvej 5, Copenhagen DK-2100, Denmark
| | - Janina Petkevičienė
- Faculty of Public Health, Health Research Institute, Lithuanian University of Health Sciences, Tilzes Str. 18, Kaunas 47181, Lithuania
- Faculty of Public Health, Department of Preventive Medicine, Lithuanian University of Health Sciences, Tilzes Str. 18, Kaunas 47181, Lithuania
| | - Ričardas Radišauskas
- Faculty of Public Health, Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Tilzes Str. 18, Kaunas 47181, Lithuania
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu Ave. 15, Kaunas 50162, Lithuania
| | - Rainer Reile
- Faculty of Public Health, Health Research Institute, Lithuanian University of Health Sciences, Tilzes Str. 18, Kaunas 47181, Lithuania
- Department for Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, Tallinn 11619, Estonia
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Victoria 3086, Australia
- Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, Stockholm 106 91, Sweden
| | - Relika Stoppel
- Faculty of Public Health, Health Research Institute, Lithuanian University of Health Sciences, Tilzes Str. 18, Kaunas 47181, Lithuania
| | - Ilona Tamutienė
- Faculty of Public Health, Health Research Institute, Lithuanian University of Health Sciences, Tilzes Str. 18, Kaunas 47181, Lithuania
- Department of Public Administration, Faculty of Political Science and Diplomacy at Vytautas Magnus University, V.Putvinskio Str 23, Kaunas LT-44243, Lithuania
| | - Alexander Tran
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario M5S 2S1, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - Justina Trišauskė
- Faculty of Public Health, Health Research Institute, Lithuanian University of Health Sciences, Tilzes Str. 18, Kaunas 47181, Lithuania
| | - Mateusz Zatoński
- Institute – European Observatory of Health Inequalities, Calisia University, Nowy Swiat 4, Kalisz 62-800, Poland
| | - Witold A. Zatoński
- Institute – European Observatory of Health Inequalities, Calisia University, Nowy Swiat 4, Kalisz 62-800, Poland
- Health Promotion Foundation, Mszczonowska 51, Nadarzyn 05-830, Poland
| | - Ingrida Zurlytė
- WHO Country Office Lithuania, A. Jakšto g. 12, LT-01105 Vilnius, Lithuania
| | - Mindaugas Štelemėkas
- Faculty of Public Health, Health Research Institute, Lithuanian University of Health Sciences, Tilzes Str. 18, Kaunas 47181, Lithuania
- Faculty of Public Health, Department of Preventive Medicine, Lithuanian University of Health Sciences, Tilzes Str. 18, Kaunas 47181, Lithuania
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Lahtinen H, Moustgaard H, Ripatti S, Martikainen P. Association between genetic risk of alcohol consumption and alcohol-related morbidity and mortality under different alcohol policy conditions: Evidence from the Finnish alcohol price reduction of 2004. Addiction 2023; 118:678-685. [PMID: 36564914 DOI: 10.1111/add.16118] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022]
Abstract
AIMS Harmful alcohol consumption is influenced by both genetic susceptibility and the price of alcohol. Many previous studies have observed that genetic susceptibility to consumption of alcohol is more predictive in less restrictive drinking conditions. We assess whether such a pattern applies when the prices of alcoholic beverages are decreased. DESIGN Data consist of genetically informed population-representative surveys (FINRISK 1992, 1997, 2002 and Health 2000) linked to administrative registers. We analysed the interaction between a polygenic score (PGS) for alcoholic drinks per week consumed and price reduction in predicting the incidence of alcohol-related hospitalizations and deaths in difference-in-difference and interrupted time-series frameworks. SETTING Individuals in Finland were followed quarter-yearly from 1 March 2000 to 31 May 2008. PARTICIPANTS A total of 22 152 individuals (607 132-person quarter-years, 1399 outcome events) aged 30-79 years. INTERVENTION A natural experiment stemming from the alcohol tax reduction in March 2004 and import deregulation in May 2004. MEASUREMENTS Outcome was quarter-yearly-measured alcohol-related death or hospitalization. The independent variables of main interest were PGS and a price reform indicator. We adjusted for gender, age, age squared, season, 10 first principal components of the genome, data collection round and genotyping batch. FINDINGS Both alcohol price reduction and one standard deviation change in PGS were associated with alcohol-related health outcomes; odds ratios (ORs) were 1.32, 95% confidence interval (CI) = 1.13, 1.53 and 1.26, 95% CI = 1.12, 1.42 in the 8-year follow-up, respectively. The association between PGS and alcohol-related morbidity was similar before and after the alcohol price reform (PGS × price reform interaction OR = 0.96, 95% CI = 0.81, 1.14). These results were robust across different follow-up periods and measurement and analysis strategies. CONCLUSIONS Although the decrease of alcohol price in Finland in 2004 substantially increased overall alcohol-related morbidity and mortality, the genetic susceptibility to alcohol consumption did not become more manifest in predicting them.
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Affiliation(s)
- Hannu Lahtinen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Heta Moustgaard
- Helsinki Institute for Social Sciences and Humanities, University of Helsinki, Helsinki, Finland
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, University of Helsinki, Helsinki, Finland.,Max Planck Institute for Demographic Research, Rostock, Germany
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Manthey J, Jasilionis D, Jiang H, Meščeriakova O, Petkevičienė J, Radišauskas R, Štelemėkas M, Rehm J. The impact of alcohol taxation increase on all-cause mortality inequalities in Lithuania: an interrupted time series analysis. BMC Med 2023; 21:22. [PMID: 36647069 PMCID: PMC9841962 DOI: 10.1186/s12916-022-02721-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Taxation increases which reduce the affordability of alcohol are expected to reduce mortality inequalities. A recent taxation increase in Lithuania offers the unique possibility to test this hypothesis. METHODS Census-linked mortality data between 2011 and 2019 were used to calculate monthly sex- and education-stratified age-standardized mortality rates for the population aged 40 to 70 years. As primary outcome, we analysed the difference in age-standardized all-cause mortality rates between the population of lowest versus highest educational achievement. The impact of the 2017 taxation increase was evaluated using interrupted time series analyses. To identify whether changes in alcohol use can explain the observed effects on all-cause mortality, the education-based mortality differences were then decomposed into n = 16 cause-of-death groupings. RESULTS Between 2012 and 2019, education-based all-cause mortality inequalities in Lithuania declined by 18% among men and by 14% among women. Following the alcohol taxation increase, we found a pronounced yet temporary reduction of mortality inequalities among Lithuanian men (- 13%). Subsequent decomposition analyses suggest that the reduction in mortality inequalities between lower and higher educated men was mainly driven by narrowing mortality differences in injuries and infectious diseases. CONCLUSIONS A marked increase in alcohol excise taxation was associated with a decrease in mortality inequalities among Lithuanian men. More pronounced reductions in deaths from injuries and infectious diseases among lower as compared to higher educated groups could be the result of differential changes in alcohol use in these populations.
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Affiliation(s)
- Jakob Manthey
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany. .,Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Domantas Jasilionis
- Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Konrad-Zuse-Str. 1, 18057, Rostock, Germany.,Demographic Research Centre, Faculty of Social Sciences, Vytautas Magnus University, Jonavos Str. 66, 44191, Kaunas, Lithuania
| | - Huan Jiang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Olga Meščeriakova
- Department of Health Management, Faculty of Public Health, Lithuanian University of Health Sciences, Tilžės 18, 47181, Kaunas, Lithuania
| | - Janina Petkevičienė
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Tilžės 18, 47181, Kaunas, Lithuania.,Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Tilžės 18, 47181, Kaunas, Lithuania
| | - Ričardas Radišauskas
- Department of Environmental and Occupational Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Tilžės 18, 47181, Kaunas, Lithuania.,Institute of Cardiology, Lithuanian University of Health Sciences, Sukilėlių Av. 15, 50162, Kaunas, Lithuania
| | - Mindaugas Štelemėkas
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Tilžės 18, 47181, Kaunas, Lithuania.,Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Tilžės 18, 47181, Kaunas, Lithuania
| | - Jürgen Rehm
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.,Department of Psychiatry, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5T 2S1, Canada.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya Str., 8, B. 2, 119992, Moscow, Russian Federation
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de Oliveira CWL, Mendes CV, Kiepper A, Monteiro MG, Wagner GA, Sanchez ZM. Analysis of gaps in alcohol policies in Brazil using the Pan American Health Organization's Alcohol Policy Scoring. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103322. [PMID: 34271251 DOI: 10.1016/j.drugpo.2021.103322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 05/14/2021] [Accepted: 05/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND National alcohol policies need to be systematized and evaluated to identify the gaps that should be filled by future laws. This study aims to search for and classify Brazilian public alcohol policies at the federal and state levels, based on the ten Alcohol Policy Scoring (APS) domains used by the Pan American Health Organization (PAHO), to identify any gaps METHODS: Documental research was carried out in two phases: document identification and content analysis. The search included laws, decrees, and ordinances for alcohol referred to in this text as regulatory documents (RD), enacted until December 31, 2019, in Brazil and its 26 states and the Federal District. The APS was used to classify and score the RD, which consists of ten policy domains (including pricing, availability, marketing, and health services), weighted according to the level of scientific evidence of each strategy RESULTS: We identified and categorized 435 valid RD (21 national laws and 414 state laws). Overall, Brazilian alcohol policies account for 51.6% (255/494) of the APS score. In the pricing policy domain, the second most robust indicator of the APS, the policy gap reached 87% in 25 states, demonstrating a weakness. Only the federal laws against drink-driving include all the recommended dimensions. There are important legislative contradictions in the definition of an alcoholic beverage and in the content of the policies to control marketing CONCLUSION: At the national level, the federal government adopted alcohol policies in several of the PAHO policy domains but enacted RD with little practical effect. At the subnational level, despite the autonomy to complement federal laws, the states have not yet addressed the most important gaps.
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Affiliation(s)
- Camila W Lopes de Oliveira
- Departamento de Psiquiatria e Psicologia Médica. Universidade Federal de São Paulo, São Paulo, Brazil. Rua Borges Lagoa, 570 - 1º Andar - São Paulo, SP, Brazil
| | - Camila Vieira Mendes
- Departamento de Medicina Preventiva, Universidade Federal de São Paulo, São Paulo, Brazil. Rua Botucatu, 740, 4° andar, São Paulo, SP, Brazil
| | | | - Maristela G Monteiro
- Noncommunicable Diseases and Mental Health Department, Pan American Health Organization (PAHO), 525 Twenty-third Street, N.W., Washington, DC 20037, United States
| | - Gabriela Arantes Wagner
- Departamento de Medicina Preventiva, Universidade Federal de São Paulo, São Paulo, Brazil. Rua Botucatu, 740, 4° andar, São Paulo, SP, Brazil
| | - Zila M Sanchez
- Departamento de Medicina Preventiva, Universidade Federal de São Paulo, São Paulo, Brazil. Rua Botucatu, 740, 4° andar, São Paulo, SP, Brazil.
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Delavary Foroutaghe M, Mohammadzadeh Moghaddam A, Fakoor V. Impact of law enforcement and increased traffic fines policy on road traffic fatality, injuries and offenses in Iran: Interrupted time series analysis. PLoS One 2020; 15:e0231182. [PMID: 32302374 PMCID: PMC7164613 DOI: 10.1371/journal.pone.0231182] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/17/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Road traffic law enforcement was implemented on 1st April 2011 (the first intervention) and traffic ticket fines have been increased on 1st March 2016 (the second intervention) in Iran. The aim of the current study was to evaluate the effects of the law enforcement on reduction in the incidence rate of road traffic fatality (IRRTF), the incidence rate of road traffic injuries (IRRTI) and the incidence rate of rural road traffic offenses (IRRRTO) in Iran. METHODS Interrupted time series analysis was conducted to evaluate the impact of law enforcement and increased traffic tickets fines. Monthly data of fatality on urban, rural and local rural roads, injuries with respect to gender and traffic offenses namely speeding, illegal overtaking and tailgating were investigated separately for the period 2009-2016. RESULTS Results showed a reduction in the incidence rate of total road traffic fatality (IRTRTF), the incidence rate of rural road traffic fatality (IRRRTF) and the incidence rate of urban road traffic fatality (IRURTF) by -21.44% (-39.3 to -3.59, 95% CI), -21.25% (-31.32 to -11.88, 95% CI) and -26.75% (-37.49 to -16, 95% CI) through the first intervention which resulted in 0.383, 0.255 and 0.222 decline in casualties per 100 000 population, respectively. Conversely, no reduction was found in the incidence rate of local rural road traffic fatality (IRLRRTF) and the IRRTI. Second intervention was found to only affect the IRURTF with -26.75% (-37.49 to -16, 95% CI) which led to 0.222 casualties per 100 000 population. In addition, a reduction effect was observed on the incidence rate of illegal overtaking (IRIO) and the incidence rate of speeding (IRS) with -42.8% (-57.39 to -28.22, 95% CI) and -10.54% (-21.05 to -0.03, 95% CI which implied a decrease of 415.85 and 1003.8 in monthly traffic offenses per 100 000 vehicles), respectively. CONCLUSION Time series analysis suggests a decline in IRTRTF, IRRRTF, and IRURTF caused by the first intervention. However, the second intervention found to be only effective in IRURTF, IRIO, and IRS with the implication that future initiatives should be focused on modifying the implementation of the traffic interventions.
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Affiliation(s)
- Milad Delavary Foroutaghe
- Department of Civil Engineering, Faculty of Engineering, Ferdowsi University of Mashhad, Mashhad, Razavi Khorasan, Iran
| | | | - Vahid Fakoor
- Department of Statistics, Faculty of Mathematical Sciences, Ferdowsi University of Mashhad, Mashhad, Razavi Khorasan, Iran
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Herttua K, Östergren O, Lundberg O, Martikainen P. Influence of affordability of alcohol on educational disparities in alcohol-related mortality in Finland and Sweden: a time series analysis. J Epidemiol Community Health 2017; 71:1168-1176. [PMID: 29061845 DOI: 10.1136/jech-2017-209636] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Prices of alcohol and income tend to influence how much people buy and consume alcohol. Price and income may be combined into one measure, affordability of alcohol. Research on the association between affordability of alcohol and alcohol-related harm is scarce. Furthermore, no research exists on how this association varies across different subpopulations. We estimated the effects of affordability of alcohol on alcohol-related mortality according to gender and education in Finland and Sweden. METHODS Vector-autoregressive time series modelling was applied to the quarter-annual aggregations of alcohol-related deaths and affordability of alcohol in Finland in 1988-2007 and in Sweden in 1991-2008. Alcohol-related mortality was defined using information on both underlying and contributory causes of death. We calculated affordability of alcohol index using information on personal taxable income and prices of various types of alcohol. RESULTS Among Finnish men with secondary education, an increase of 1% in the affordability of total alcohol was associated with an increase of 0.028% (95% CI 0.004 to 0.053) in alcohol-related mortality. Similar associations were also found for affordability for various types of alcohol and for beer only in the lowest education group. We found few other significant positive associations for other subpopulations in Finland or Sweden. However, reverse associations were found among secondary-educated Swedish women. CONCLUSIONS Overall, the associations between affordability of alcohol and alcohol-related mortality were relatively weak. Increased affordability of total alcoholic beverages was associated with higher rates of alcohol-related mortality only among Finnish men with secondary education.
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Affiliation(s)
- Kimmo Herttua
- Department of Public Health, Centre of Maritime Health and Society, University of Southern Denmark, Esbjerg, Denmark.,Department of Social Research, Population Research Unit, University of Helsinki, Helsinki, Finland
| | - Olof Östergren
- Centre for Health Equity Studies, Stockholm University and Karolinska Institutet, Stockholm, Sweden
| | - Olle Lundberg
- Centre for Health Equity Studies, Stockholm University and Karolinska Institutet, Stockholm, Sweden
| | - Pekka Martikainen
- Department of Social Research, Population Research Unit, University of Helsinki, Helsinki, Finland.,Centre for Health Equity Studies, Stockholm University and Karolinska Institutet, Stockholm, Sweden.,The Max Planck Institute for Demographic Research, Rostock, Germany
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Boniface S, Scannell JW, Marlow S. Evidence for the effectiveness of minimum pricing of alcohol: a systematic review and assessment using the Bradford Hill criteria for causality. BMJ Open 2017; 7:e013497. [PMID: 28588106 PMCID: PMC5777460 DOI: 10.1136/bmjopen-2016-013497] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES To assess the evidence for price-based alcohol policy interventions to determine whether minimum unit pricing (MUP) is likely to be effective. DESIGN Systematic review and assessment of studies according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, against the Bradford Hill criteria for causality. Three electronic databases were searched from inception to February 2017. Additional articles were found through hand searching and grey literature searches. CRITERIA FOR SELECTING STUDIES We included any study design that reported on the effect of price-based interventions on alcohol consumption or alcohol-related morbidity, mortality and wider harms. Studies reporting on the effects of taxation or affordability and studies that only investigated price elasticity of demand were beyond the scope of this review. Studies with any conflict of interest were excluded. All studies were appraised for methodological quality. RESULTS Of 517 studies assessed, 33 studies were included: 26 peer-reviewed research studies and seven from the grey literature. All nine of the Bradford Hill criteria were met, although different types of study satisfied different criteria. For example, modelling studies complied with the consistency and specificity criteria, time series analyses demonstrated the temporality and experiment criteria, and the analogy criterion was fulfilled by comparing the findings with the wider literature on taxation and affordability. CONCLUSIONS Overall, the Bradford Hill criteria for causality were satisfied. There was very little evidence that minimum alcohol prices are not associated with consumption or subsequent harms. However the overall quality of the evidence was variable, a large proportion of the evidence base has been produced by a small number of research teams, and the quantitative uncertainty in many estimates or forecasts is often poorly communicated outside the academic literature. Nonetheless, price-based alcohol policy interventions such as MUP are likely to reduce alcohol consumption, alcohol-related morbidity and mortality.
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Affiliation(s)
- Sadie Boniface
- Department of Psychology and Neuroscience, National Addiction Centre, Institute of Psychiatry, King's College London, London, UK
| | - Jack W Scannell
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Sally Marlow
- Department of Psychology and Neuroscience, National Addiction Centre, Institute of Psychiatry, King's College London, London, UK
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Tarkiainen L, Martikainen P, Laaksonen M. The contribution of education, social class and economic activity to the income-mortality association in alcohol-related and other mortality in Finland in 1988-2012. Addiction 2016; 111:456-64. [PMID: 26477592 DOI: 10.1111/add.13211] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/03/2015] [Accepted: 10/09/2015] [Indexed: 01/02/2023]
Abstract
AIMS First, to quantify trends in the contribution of alcohol-related mortality to mortality disparity in Finland by income quintiles. Secondly, to estimate the degree to which education, social class and economic activity explain the income-mortality association in alcohol-related and other mortality in four periods within 1988-2012. DESIGN Register-based longitudinal study using an 11% random sample of Finnish residents linked to socio-economic and mortality data in 1988-2012 augmented with an 80% sample of all deaths during 1988-2007. Mortality rates and discrete time survival regression models were used to assess the income-mortality association following adjustment for covariates in 6-year periods after baseline years of 1988, 1994, 2001, and 2007. SETTING Finland. PARTICIPANTS Individuals aged 35-64 years at baselines. For the four study periods for men/women, the final data set comprised, respectively, 26,360/12,825, 22,561/11,423, 20,342/11,319 and 2651/1514 deaths attributable to other causes and 7517/1217, 8199/1450, 9807/2116, 1431/318 deaths attributable to alcohol-related causes. MEASUREMENTS Alcohol-related deaths were analysed with household income, education, social class and economic activity as covariates. FINDINGS The income disparity in mortality originated increasingly from alcohol-related causes of death, in the lowest quintile the contribution increasing from 28 to 49% among men and from 11 to 28% among women between periods 1988-93 and 2007-12. Among men, socio-economic characteristics attenuated the excess mortality during each study period in the lowest income quintile by 51-62% in alcohol-related and other causes. Among women, in the lowest quintile the attenuation was 47-76% in other causes, but there was a decreasing tendency in the proportion explained by the covariates in alcohol-related mortality. CONCLUSIONS The income disparity in mortality among working-age Finns originates increasingly from alcohol-related causes of death. Roughly half the excess mortality in the lowest income quintile during 2007-12 is explained by the covariates of household income, education, social class and economic activity.
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Affiliation(s)
- Lasse Tarkiainen
- Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Mikko Laaksonen
- Finnish Centre for Pensions, Research Department, Helsinki, Finland
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Calle P, Hautekiet A, François H, Sundahl N, Cornelis C, Calle S, Damen J, Vanbrabant P, De Turck B, De Graeve K, Mpotos N, De Paepe P. Alcohol-related emergency department admissions among adolescents in the Ghent and Sint-Niklaas areas. Acta Clin Belg 2015; 70:345-9. [PMID: 25984783 DOI: 10.1179/2295333715y.0000000031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Alcohol abuse is a major health concern. The aim of this retrospective study was to analyse the alcohol-related emergency department (ED) admissions among adolescents in all hospitals of distinct areas during a 1-year period. In each hospital, all ED patients with a blood alcohol concentration (BAC) of at least 0.5 g/l were surveyed in a standardised way. Of the 3918 included patients, only 146 (3.7%) were < 18 years. The male-to-female ratio was 1.5:1. There was a strong preponderance of weekend and night time admissions. Most of the patients were transported by ambulance (77% of 138 patients with information on this item). The main reason for ED admittance was depressed level of consciousness (64%), trauma (12%), vomiting and/or abdominal pain (12%), agitation or aggression (4%), syncope (4%) and psychological problems (4%). The context of the alcohol intoxication was related to some kind of festivity in 85%, mental problems in 14% and chronic abuse in 1%. Median BAC values (and range) were 2.08 g/l (0.73-3.70 g/l) for boys and 1.51 g/l (0.73-2.90 g/l) for girls. Most patients (87%) could be discharged home within 24 hours. Our study confirms that problematic alcohol use leading to ED admissions starts in adolescence. Although the numbers of cases below 18 years are low when compared to adults, the phenomenon is alarming as it is associated with substantial health problems. Therefore, Belgium urgently needs a global national alcohol plan, with youngsters being one of the target groups.
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Affiliation(s)
- P Calle
- Emergency Department, Maria Middelares General Hospital , Ghent, Belgium
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Mäkelä P, Herttua K, Martikainen P. The Socioeconomic Differences in Alcohol-Related Harm and the Effects of Alcohol Prices on Them: A Summary of Evidence from Finland. Alcohol Alcohol 2015; 50:661-9. [PMID: 26113490 DOI: 10.1093/alcalc/agv068] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS We make a case study of Finland to study the connections between socioeconomic status, alcohol use, related harm and possibilities for intervention by means of alcohol pricing. METHODS A review of Finnish studies on the topic. RESULTS The socioeconomic differences in severe alcohol-related harm were great, and in the past two decades, these differences have widened. Alcohol-related mortality has also strongly contributed to both the level and widening of socioeconomic differences in life expectancy. Both in 2004, when alcohol prices were abruptly cut, and in the longer term with more gradual changes in lowest prices of alcohol, the lowest socioeconomic groups were most affected in absolute-but not so clearly in relative-terms, particularly among men. However, these effects are sometimes weak, not fully consistent by gender and across different measures of harm. CONCLUSIONS The large and increasing socioeconomic differences in alcohol-related harm in Finland underline the importance of reducing these differences. The finding that particularly among men the impact of reduced alcohol prices on health has often in absolute terms been the greatest in the lower socioeconomic groups suggests that policies aimed at keeping the price of alcoholic beverages high may help to both minimize the overall level of alcohol-related health problems and to reduce absolute inequalities.
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Affiliation(s)
- Pia Mäkelä
- Alcohol and Drugs Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Kimmo Herttua
- Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland Centre of Maritime Health and Society, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - Pekka Martikainen
- Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland Max Planck Institute for Demographic Research, Rostock, Germany
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