Abstract
To delineate the temporal dynamics between alcohol tax policy changes and related health outcomes, this study examined the age, period and cohort effects on alcohol-related mortality in relation to changes in government alcohol policies. We used the age-period-cohort modeling to analyze retrospective mortality data over 30 years from 1981 to 2010 in a rapidly developed Chinese population, Hong Kong. Alcohol-related mortality from 1) chronic causes, 2) acute causes, 3) all (chronic+acute) causes and 4) causes 100% attributable to alcohol, as defined according to the Alcohol-Related Disease Impact (ARDI) criteria developed by the US Centers for Disease Control and Prevention, were examined. The findings illustrated the possible effects of alcohol policy changes on adult alcohol-related mortality. The age-standardized mortality trends were generally in decline, with fluctuations that coincided with the timing of the alcohol policy changes. The age-period-cohort analyses demonstrated possible temporal dynamics between alcohol policy changes and alcohol-related mortality through the period effects, and also generational impact of alcohol policy changes through the cohort effects. Based on the illustrated association between the dramatic increase of alcohol imports in the mid-1980s and the increased alcohol-related mortality risk of the generations coming of age of majority at that time, attention should be paid to generations coming of drinking age during the 2007–2008 duty reduction.
Highlights
It has long been shown that government alcohol policies such as taxation directly influence the quantity of alcoholic beverages imported and sold in a country, which, in turn, correlate strongly with population alcohol consumption levels
Three major alcohol tax policy changes have since taken place that significantly influenced the quantity of alcoholic beverages imported into Hong Kong
A recent time-series study [17] suggested an association between the 2007 alcohol duty reduction and increased cardiovascular mortality in Hong Kong from 2001 to 2010, no Chinese studies have ever simultaneously modeled the three time-related factors of age, period and cohort, which is necessary to delineate the temporal dynamics between alcohol tax policy changes and related health outcomes
Summary
It has long been shown that government alcohol policies such as taxation directly influence the quantity of alcoholic beverages imported and sold in a country, which, in turn, correlate strongly with population alcohol consumption levels. In order to increase revenues from the hospitality industry, to capitalize on greater tourism and to promote Hong Kong as Asia’s foremost wine hub [15,16], an unprecedented sequential change in alcohol tax policy occurred in 2007 and 2008 when alcohol tax was reduced and altogether eliminated, respectively. These two successive large-scale duty reductions resulted in an exponential growth of alcohol imports. Given that the social drinking trends in the West differ from that observed in Hong Kong Chinese society where there is generally less heavy drinking [18,19,20], implications can be telling
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