Fatal Traumatic Brain Injuries During 13 Years of Successive Alcohol Tax Increases in Finland - A Nationwide Population-Based Registry Study

Abstract

We sought to investigate how increases in alcohol taxation and changes in alcohol consumption were associated with the incidence rate of fatal traumatic brain injuries (TBI) in Finland during the years 2004-2016. Nationwide, mandatory cause of death database covering all deaths in Finland was searched for all deaths related to TBIs (ICD-10: S06.X) in persons ≥16 years of age during 2004-2016. Study period included 28,657,870 person-years and 325,514 deaths of which 12,110 were TBIrelated. Occurrence rates were standardized to European 2013 standard population. Data for alcohol consumption were obtained from the National Institute for Health and Welfare and for alcohol taxation from Ministry of Finance, Finland. Standardized incidence rate of TBI-related death was 22.0 (95% CI 21.61-22.38) per 100,000 person-years. Overall alcohol consumption decreased on average by 1.2% annually. Concurrently, the overall incidence rate of fatal TBIs decreased by 4.1% annually (by 4.3% in men and 2.4% in women). There was an association between overall alcohol consumption and TBI-related mortality rate (p < 0.001). Tax-rate increases of all beverage types were associated with decreased incidence rate of TBI-related death in men (p < 0.001), in women (p < 0.036) and overall (p < 0.001). In this population-based study, we report that during 13 years of successive alcohol tax increases, overall alcohol consumption has decreased in parallel with a reduction in the incidence rate of fatal TBIs in Finland.Traumatic brain injury (TBI) is a substantial global health problem and a frequent cause of injury-related death 1,2 . The US Centers for Disease Control and Prevention (CDC) has reported a population-based TBI-related mortality rate of 17.1 per 100,000 person-years in 2010 3 , while in Europe, a pooled mortality rate of 11.7 per 100,000 person-years in 2012 has been reported 2 . Up to half of the patients who sustain TBI are intoxicated with ethanol at the time of injury [4][5][6] .Finnish alcohol control has been based on three factors: a strict state-controlled availability of alcohol, a monopoly on alcohol production and trade, and high alcohol beverage prices. Since Finland joined the EU in 1995, the system has partially dissolved. In 2004, the excise tax on alcoholic beverages was reduced markedly and alcoholic beverage prices declined by 33% with the most pronounced relative price reduction in strong alcoholic beverages. This lead to a 10% increase in overall alcohol consumption 7 . In Northern Finland, alcohol-related fatal TBIs increased among middle-aged people in 2006-2007 compared to 1999, while the total number of fatal TBIs remained unchanged 8 . To reduce health hazards, swift increases in alcohol taxes were subsequently undertaken with a focus on strong alcohol taxation. By 2016, overall alcohol taxation had reached almost the same level it had