How did alcohol control policies reduce all-cause mortality in Baltic countries and Poland?

By Tarun Sai LomteReviewed by Lily Ramsey, LLMApr 20 2023

A recent study published in the Scientific Reports Journal examined the impact of alcohol control policies on all-cause mortality between 2001 and 2020.

Study: Alcohol control policies reduce all-cause mortality in Baltic Countries and Poland between 2001 and 2020. Image Credit: Pixel-shot/Shutterstock.com

Background

Alcohol is a major risk factor for non-communicable diseases and injuries. In the European region, around 10% of deaths were alcohol-attributable in 2016. Moreover, alcohol-attributable fractions are the highest in this region.

However, effective alcohol control policies can decrease all-cause mortality and alcohol-attributable deaths and increase life expectancy.

Three best-buys policies have been reported to be effective, easily implementable, and cost-effective. Baltic states implemented different levels of restrictions on alcohol availability, marketing, and affordability in the last two decades.

In contrast, Poland introduced higher taxation in 2020 but loosened control by reducing alcohol excise taxation in 2002.

About the study

In the present study, researchers investigated the impact of alcohol control policies implemented in Poland, Estonia, Lithuania, and Latvia on all-cause mortality among adults from 2001 to 2020.

Data for 2001-20 for Baltic states were obtained from Statistics Estonia, the Official Statistics of Latvia, Statistics Lithuania, and the State Register of Death Cases and their causes, and for 2001-19 from Poland's National Statistical Office.

Data from December 2020 were excluded to avoid the high impact of the coronavirus disease 2019 (COVID-19) pandemic in the month.

 Mortality count data were transformed into rates for the Organization for Economic Cooperation and Development (OECD) countries. The dependent variable was the monthly all-cause mortality rate per 100,000 individuals aged 20 or above.

Mortality was estimated during one year before and after the policy was implemented. Overall, 18 policies were applied during the study period.

They were introduced on the basis that increased taxation should reduce affordability, and availability restrictions should result in at least 20% reductions in the availability of alcoholic beverages.

Eight policies were selected in Estonia, five in Latvia, four in Lithuania, and one in Poland. The effects were modeled for one-year post-policy implementation. They also evaluated interactions between countries and policies to determine whether other events in the country at implementation influenced the impact.

The team conducted interrupted time-series analyses using a generalized additive mixed model (GAMM) for males and females, adjusting for the economic recession. They assessed policy effects in full and reduced models.

Linear time trends and policy effects were evaluated in the full model, adjusted by countries, economic recession, and the interactions between countries and policies. In the reduced model, non-significant covariates were excluded.  

Findings

The researchers analyzed data for 240 months. The standardized mortality rates decreased over time with seasonal variations, and GAMM confirmed the decrease in mortality rates with time. The effects of policies were similar in reduced and full models. The policies caused a significant impact on all-cause mortality among males in the reduced model, reflecting a 2.3% reduction.

The policies had a non-significant effect of a 1.09% decrease in all-cause mortality for females. Latvia, Lithuania, and Estonia showed higher age-standardized mortality rates than Poland. The interactions between countries and policies were insignificant in the full model, implying that policies had no differential changes in mortality rates across countries.

Estonia and Latvia also had higher age-standardized mortality rates for females than Poland, whereas Lithuania had a lower mortality rate. Consistent with males, interactions between countries and policies were insignificant in the full model.

The authors noted that males had overall higher mortality gains than females. The largest mortality gains were observed for ischemic heart disease, injury, stroke, and gastrointestinal disease, all linked causally to alcohol.

There were minor changes in cancer mortality. The team performed sensitivity analyses assuming that policies have effects longer than one year that decrease 10% per year to account for inflation, adaptation to availability restrictions, and higher disposable income. They found that alcohol control policies no longer significantly affected mortality.

Conclusions

The alcohol control policies introduced in the Baltic and Poland significantly reduced all-cause mortality among adult males, preventing 967 and 4,340 deaths per year, respectively. Sub-sample analysis by the cause of death confirmed that the reductions were based on deaths attributable to alcohol use.

Although the policies reduced mortality among females, the effect was non-significant. The findings, therefore, suggest that the alcohol control policies should be continued.