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

Abstract

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.

Alcohol: No Ordinary Commodity—a summary of the third edition

“…For instance, in both Lithuania and Russia, recent measures making alcohol more expensive, less readily available and less heavily promoted have been mutually supportive and resulted in substantial reductions in levels of alcohol consumption and alcohol-related harms [92,93]. Particularly in countries with very high consumption levels, dramatic improvements in life expectancy can be achieved through a combination of alcohol control measures [7,[92][93][94].…”

The temporal trend of cause-specific mortality: comparing Estonia and Lithuania, 2001 – 2019

“…In Estonia, given that the decline in cancer mortality rate (approximate 30 deaths per 100,000 individuals) was not as steep as all other CVD (600 deaths per 100,000 individuals) this explains the increasing proportion due to cancer deaths. Some of the change in all other CVD mortality rate may reflect a change in coding practices in the reporting of causes of death (differences in coding practices have been also reported elsewhere, [ 18 ]), with decreasing emphasis on IHD as a cause of death. Still, when combining any CVD-related cause of death, it is clear that the cardiovascular diseases (i.e., cerebrovascular, ischemic heart disease, all other CVD), exhibited a downward trend in Estonia that was steeper than Lithuania (see Supplementary Materials ).…”

“…Estonia and Lithuania were part of the Soviet Union, until the restoration of their formal independence in 1991 (de facto in 1990), and these two countries share some sociocultural characteristics. Both countries have a culture of heavy drinking including heavy episodic drinking, which may have contributed to relatively higher liver cirrhosis mortality rates compared to some other European countries [ 13 , 16 – 18 ].

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The impact of alcohol taxation increase on all-cause mortality inequalities in Lithuania: an interrupted time series analysis

“…However, the 2017 taxation increase was classified as the policy which most likely impacts on health [ 16 ] and previous all-cause and cause-specific analyses have also found more support for this than for other policies (e.g. for liver cirrhosis, see [ 20 ]). Lastly, we considered to control for several social and economic variables but cannot fully exclude residual confounding.…”

“…This measure has not only decreased affordability of alcoholic beverages [16], but has also been linked to lower all-cause mortality rates [17,18]. The reduction in national mortality rates were most notable among younger adults [19] and were also observed for liver cirrhosis and suicide deaths [20,21], which had shown the highest rates among the most socioeconomically disadvantaged populations in various high-income countries [22][23][24].…”