Weekly pattern of alcohol-attributable male mortality before and after imposing limits on hours of alcohol sale in Lithuania in 2018

Abstract

Aims: From 1 January 2018, the number of retail hours for the sale of alcohol was reduced from 14 to 5 hours on Sundays and from 14 to 10 hours on the other days of the week in Lithuania. The significant reduction of hours for the sale of alcohol on Sundays may have affected the distribution of alcohol-attributable deaths during the week. This study aimed to examine the change in the weekly pattern of alcohol-attributable male mortality before and after imposing limits on the hours when alcohol can be sold. Methods: Age-standardised male death rates by days of the week were calculated for four groups according to cause of death: alcohol poisoning (X45), all external causes of death (V01–Y98), diseases of the circulatory system (I00–I99) and all other causes of death. We compared age-standardised death rates for two periods: before (2015–2017) and after (2018–2019) the intervention. Mortality and population data were obtained from the Lithuanian Institute of Hygiene and Human Mortality Database. Results: We found that during 2018–2019, earlier observed peak in age-standardised death rates for external causes of death on Sunday diminished, and this day no longer differed from the weekly average. The same tendency was also observed for the Monday excess mortality due to circulatory diseases. Conclusions: The reduction of the hours when alcohol can be sold from the beginning of 2018 was associated with a change in a weekly pattern of alcohol-attributable male mortality. However, more studies are needed to examine the causes of the change in mortality pattern.

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

“…This has also been corroborated using a different direct methodology approach examining changes after major policy implementation. Stumbrys and colleagues [ 13 ] showed that the typical increases in CVD mortality on Mondays, which had been found in Lithuania and other post-Soviet countries…”

“…In the absence of Lithuania-specific RRs, and based on the current evidence, we argue that Russian RRs better describe the CVD burden in males, due to their high prevalence of episodic heavy drinking— especially important for ischemic disease [ 44 , 54 ] which has been linked to an overall irregular drinking pattern with many abstinent days but a high overall level of consumption [ 13 , 65 ]. We further base our argument on the direct results of earlier studies which have shown an impact from the implementation of major alcohol control policies (see examples in the last paragraph).…”

“…We will discuss whether the two sets of RRs yield different conclusions with respect to alcohol-attributable burden, and with respect to the impact of alcohol control policies (see also [ 11 – 13 ]). Given the high levels of alcohol consumption in Lithuania, we hypothesize: (a) a high correlation between alcohol-attributable mortality and life expectancy, and (b) marked associations between alcohol control policies and alcohol-attributable mortality and life expectancy.…”

The role of public health in controlling the burden of alcohol-related harm

“…Even though the policy of more significant reduction of alcohol sale hours was justified using past research arguments showing that alcohol could be associated with higher mortality burden during the weekends, this policy was widely criticized. The opposing interest groups described it as "ineffective" or "illogical"; however, the independent analysis led by Dr. Daumantas Stumbrys [1] demonstrated a positive effect of the alcohol control policy in reducing the alcohol-related mortality in men. After comparing mortality cases from external causes and cardiovascular disease it was demonstrated that the mortality has been reduced on Sundays (for external causes) and Mondays (for cardiovascular disease).…”