How to quantify deaths averted derived from interrupted time-series analyses

Jiang, Huan; Tran, Alexander; Gmel, Gerhard; Lange, Shannon; Manthey, Jakob; Room, Robin; Rovira, Pol; Štelemėkas, Mindaugas; Telksnys, Tadas; Rehm, Jürgen

doi:10.1101/2021.03.23.21254181

Cited by 4 publications

(5 citation statements)

References 15 publications

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“…It was surprising that restricting opening hours of alcohol sales (a ‘best buy’ policy included in Policy 3) had no discernable effect on cirrhosis mortality rates, but this null finding may be due to its position in the time series, that is, the policy was implemented towards the end of the dataset with insufficient data points to establish this effect. A recent simulation study found that when policy effects are positioned towards the end of a dataset, the estimated impact of a policy effect may not be as accurately captured with an interrupted time‐series analysis 32 . In addition, the null effect of the various measures in Policy 3 may also have been be due to the fact that this intervention is expected to have more of an impact on causes of death associated with acute harm due to alcohol (rather than a chronic disease) 37‐39 or in the case of advertisement and marketing restrictions, have more long term effects via changing the culture 40 .…”

Section: Discussionmentioning

confidence: 99%

“…To estimate the impact of the significant policy effects, we produced a counterfactual estimate of the mortality rate for the policies. Based on the methods of Jiang et al, 32 for each significant policy, we created a GAMM model for the mortality rates leading up to their implementation based on the covariates only. We then used these counterfactual GAMM models (models without the policy effect included) to predict the mortality rate for the 12 months following the introduction of the policy.…”

Section: Methodsmentioning

confidence: 99%

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

Tran

Jiang

Lange

et al. 2022

Liver International

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Tran

Jiang

Lange

et al. 2022

Liver International

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“…Direct Methodology Deaths avoided were directly estimated using methodology based on interrupted time-series [21,22]. As these procedures have been reported in detail elsewhere [20,23], the models will only be briefly described here. The methodology compares the actual deaths after an intervention, with an estimate of the deaths which would have happened without the intervention.…”

Section: Methodsmentioning

confidence: 99%

Using Direct and Indirect Estimates for Alcohol-Attributable Mortality: A Modelling Study Using the Example of Lithuania

Rehm¹,

Jiang²,

Kim³

et al. 2023

Eur Addict Res

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Introduction: Comparative risk assessments (CRAs) for alcohol use are based on indirect estimates of attributable harm, and usually combine country-specific exposure estimates and global risk relations derived from meta-analyses. CRAs for Eastern European countries, such as Lithuania, base their risk relations not on global risk relations, but on a large Russian cohort study. The availability of a direct estimate of alcohol-attributable mortality following the 2017 implementation of a large increase in alcohol excise taxes in Lithuania has allowed a comparison of these indirect estimates with a country-specific gold standard. Methods: A statistical modelling study compared direct (predictions based on a time-series methodology) and indirect (predictions based on an attributable-fraction methodology) estimates of alcohol-attributable mortality before and after a large increase in alcohol excise taxes in Lithuania. Specifically, Russia-specific versus global relative risks were compared against the gold standard of time-series based predictions. Results: Compared to direct estimates, indirect estimates markedly underestimated the reduction of alcohol-attributable mortality 12 months post intervention by at least 63%. While both of the indirect estimates differed markedly from the direct estimates, the Russia-specific estimates were closer to the direct estimates, primarily due to higher estimates for alcohol-attributable cardiovascular mortality. Discussion: As all indirect estimates were markedly lower than direct estimates, current overall relative risks and price elasticities should be re-evaluated. In particular, global estimates should be replaced by new regional estimates based on cohort studies.

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“…We will perform interrupted time series analyses, testing the impact of the 2017 rise in alcohol excise taxation using generalized additive mixed models (following recommendations of Beard and colleagues:[22]; previous applications on Lithuanian mortality data:[15-17]). For this, we will first build baseline models with control variables (secular trend, unemployment, GDP) and then include the policy variable to test for an immediate level change in the dependent variable.…”

Section: Methods and Analysismentioning

confidence: 99%

“…[16] The most robust evidence for reduction in mortality has converged for an increase in alcohol excise taxes (111-112% for wines and beer; 23% for ethyl alcohol), implemented on 1 March 2017. [14, 17]…”

Section: Introductionmentioning

confidence: 99%

Interrupted time series analyses to assess the impact of alcohol control policy on socioeconomic inequalities in mortality in Lithuania: a study protocol

Manthey

Jasilionis

Jiang

et al. 2021

Preprint

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Introduction Alcohol use is a major risk factor for mortality. Previous studies suggest that the alcohol-attributable mortality burden is higher in lower socioeconomic strata. This project will test the hypothesis, that the 2017 increase of alcohol excise taxes for beer and wine, which was linked to lower all-cause mortality rates in previous analyses, will reduce socioeconomic mortality inequalities. Methods and analysis Data on all causes of deaths will be obtained from Statistics Lithuania. Record linkage will be implemented using personal identifiers combining data from 1) the 2011 whole-population census, 2) death records between March 1, 2011 (census date) and December 31, 2019, and 3) emigration records, for individuals aged 30 to 70 years. The analyses will be performed separately for all-cause and for alcohol-attributable deaths. Monthly age-standardized mortality rates will be calculated by sex, education, and three measures of socioeconomic status. Inequalities in mortality will be assessed using absolute and relative indicators between low and high SES groups. We will perform interrupted time series analyses, and test the impact of the 2017 rise in alcohol excise taxation using generalized additive mixed models. In these models, we will control for secular trends for economic development. Ethics and dissemination This work is part of project grant 1R01AA028224-01 by the National Institute on Alcohol Abuse and Alcoholism. It has been granted research ethics approval 050/2020 by CAMH Research Ethics Board on April 17, 2020, renewed on March 30, 2021.

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How to quantify deaths averted derived from interrupted time-series analyses

Cited by 4 publications

References 15 publications

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

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

Using Direct and Indirect Estimates for Alcohol-Attributable Mortality: A Modelling Study Using the Example of Lithuania

Interrupted time series analyses to assess the impact of alcohol control policy on socioeconomic inequalities in mortality in Lithuania: a study protocol

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