Alcohol control policies reduce all-cause mortality in Baltic Countries and Poland between 2001 and 2020

Abstract

Alcohol consumption in the Baltic countries and Poland is among the highest globally, causing high all-cause mortality rates. Contrary to Poland, the Baltic countries have adopted many alcohol control policies, including the World Health Organization (WHO) “best buys”. The aim of this study was to evaluate the impact of these policies, which were implemented between 2001 and 2020, on all-cause mortality. Monthly mortality data for men and women aged 20+ years of age in Estonia, Latvia, Lithuania, and Poland were analysed for 2001 to 2020. A total of 19 alcohol control policies, fulfilling an a-priori defined definition, were implemented between 2001 and 2020 in the countries of interest, and 18 of them could be tested. Interrupted time-series analyses were conducted by employing a generalized additive mixed model (GAMM) for men and women separately. The age-standardized all-cause mortality rate was lowest in Poland and highest in Latvia and had decreased in all countries over the time period. Taxation increases and availability restrictions had short-term effects in all countries, on average reducing the age-standardized all-cause mortality rate among men significantly (a reduction of 2.31% (95% CI 0.71%, 3.93%; p = 0.0045)). All-cause mortality rates among women were not significantly reduced (a reduction of 1.09% (95% CI − 0.02%, 2.20%; p = 0.0554)). In conclusion, the alcohol control policies implemented between 2001 and 2020 reduced all-cause mortality among men 20+ years of age in Baltic countries and Poland, and thus, the practice should be continued.

Trends of alcohol-attributable deaths in Lithuania 2001–2021: epidemiology and policy conclusions

“…To be conservative and consistent with prior analyses (e.g., [ 40 , 62 , 63 ]), we restricted the impact of policies in this paper to last for one year only. While the impact of alcohol control policies will usually last longer, depending on changes in inflation, affordability, and adaptation to availability restrictions, it is hard to determine the magnitude of the lagged effects.…”

“…Given the high level of alcohol-attributable burden in males, and the high correlation with life expectancy, lowering alcohol-attributable burden would result in narrowing this gap. In particular, analyses of taxation increases indicated a sizable decrease in all-cause mortality in males [ 40 , 56 ], thus increasing overall life expectancy.…”

“…We selected the years 2008 and 2009, and the years 2017 and 2018, as years in which significant alcohol control policies were implemented, since it was in these four years that the WHO best-buy policies were enacted—these policies had been hypothesized to have immediate impact on mortality (taxation policies that resulted in decreased affordability and an availability reduction of at least 20%; for a selection of interventions, see [ 38 , 39 ]; for impact on mortality, see [ 40 ]). The association with the various alcohol control policies was established by measuring the reduction in alcohol-attributable mortality from the year prior to the policy’s implementation to its enactment date and then comparing the difference to the average change in other years.…”

Changes in the alcohol-specific disease burden during the COVID-19 pandemic in Germany: interrupted time series analyses

“…Accordingly, GAMM are increasingly used to evaluate the impact of the COVID-19 pandemic 19 or alcohol control policies. 20 The model selection is described in the Supplementary material .…”

Alcohol consumption and the risk of all-cause and cause-specific mortality—a linear and nonlinear Mendelian randomization study

“…Natural experiments using alcohol control policies, such as tax increases and availability restrictions, support a protective effect of lower alcohol intake on all-cause mortality. 7 However, determining the causal link between moderate habitual alcohol consumption and mortality risk is challenging and while such studies have been attempted, 8 we are not aware of any published randomized controlled trials (RCTs). Mendelian randomization (MR) is a statistical technique that uses naturally occurring genetic variation, typically single nucleotide polymorphisms (SNPs), to infer a causal relationship between an exposure (in this case, alcohol consumption) and an outcome (in this case, mortality risk) 9 ( Supplementary Figure S1 , available as Supplementary data at IJE online).…”