Strong public policies can prevent alcohol-related diseases, deaths

An alcohol preparedness index (API) can help assess the establishment and strength of alcohol-related public health policies across the globe, according to a study.

Countries with a higher API have fewer deaths due to alcohol-related liver disease (ALD), cancer, alcohol-attributable hepatocellular carcinoma (HCC), and cardiovascular diseases (CVDs), with marked regional differences, as well as a lower prevalence of alcohol use disorder (AUD).

“Our results encourage the development and strengthening of alcohol-related policies worldwide,” the investigators said.

A total of 169 countries were included in the analysis. The median API in these countries was 54, with 0 being the lowest and 100 being the highest. Countries with a high API had a lower AUD prevalence (incidence rate ratio [IRR], 0.13, 95 percent confidence interval [CI], 0.03‒0.60; p=0.010). [J Hepatol 2024;80:409-418]

API also inversely correlated with ALD mortality (IRR, 0.14, 95 percent CI, 0.03‒0.79; p=0.025), neoplasm-related deaths (IRR, 0.09, 95 percent CI, 0.02‒0.40; p=0.002), alcohol-attributable HCC (IRR, 0.13, 95 percent CI, 0.02‒0.65; p=0.014), and CVDs (IRR, 0.09, 95 percent CI, 0.02‒0.41; p=0.002).

The highest associations were noted in the Americas, Africa, and Europe, and these associations became more robust over time. Interestingly, AUD prevalence significantly decreased after 2 years, while ALD mortality and alcohol-related HCC incidence dropped after 4 and 8 years from baseline API assessment, respectively (p<0.05).

“Taxes and pricing policies are among the most successful PHPs in decreasing alcohol intake and ALD,” the investigators said. “In fact, several studies have demonstrated an inverse association between taxes, alcohol consumption, and alcohol-related harmful effects.” [Am J Prev Med 2010;38:217-229]

The effect of taxes could be felt mostly by middle-aged adults and those with a low socioeconomic background, as shown in an earlier study. Previous research also found that implementing a minimum unit pricing was effective in reducing heavy-episodic drinking and ALD mortality. [Am J Epidemiol 2008;168:1110-1118; Lancet Public Health 2021;6:e557-e565]

“Still, its effectiveness could differ in other regions with a high homemade alcohol intake or illegal markets,” the investigators said.

Additionally, restricting alcohol access and regulating alcohol advertisements might help reduce alcohol-related deaths, although only a few studies have assessed its effect on ALD. [JHEP Rep 2019;1:403-413]

“Further natural experiment studies, assessing the introduction of specific policies over time and the co-occurrence of changes (both in the policy environment and in population-level health), can supplement and expand our results,” the investigators said.

“The development and implementation of alcohol-related policies should be prioritized by governments, scientific societies, and other stakeholders to address the long-term harmful effects of alcohol misuse,” they added.

The current ecological multinational study used data on alcohol-related public health policies from the WHO Global Information System of Alcohol and Health 2010. The investigators collected data on alcohol-related health consequences between 2010 and 2019 from the Global Burden of Disease database.

Public health policies were classified into five items, including criteria for low, moderate, and strong policy establishment. API was estimated using multiple correspondence analysis, and IRRs for outcomes were calculated using adjusted multilevel generalized linear models with a Poisson family distribution.