Can Alcohol Control Policies Reduce Liver Cirrhosis Mortality? An Interrupted Time Series Analysis in Lithuania

Abstract

Background: The relationship between alcohol consumption and liver cirrhosis is well established. Accordingly, policies that can influence population-level use of alcohol should, in turn, impact liver cirrhosis mortality rates. We examined the effect of alcohol control policies targeting the general population on liver cirrhosis mortality rates in Lithuania – a high-income European Union country. Methods: Age-standardized, monthly liver mortality data (deaths per 100,000 adults) from Lithuania were analyzed between 2001 – 2018 (n = 216) while controlling for economic confounders (GDP and inflation). An interrupted time series analysis was conducted to estimate the effect of three alcohol control policies implemented in 2008, 2017, and 2018. Findings: The interrupted time series analysis showed a significant effect of the 2008 (p < ·0001) and 2017 (p = ·0003) alcohol control policies (both of which involved alcohol taxation) on liver cirrhosis mortality. Specifically, our model showed that following the 2008 policy, there was a 6·20% (95% CI: 5·94 – 6·50) reduction in the liver cirrhosis mortality rate, which equated to 74 (95% CI: 68 – 78) less deaths. Further, we found that following the 2017 policy, there was an 18·95% (95% CI: 7·69 – 32·34) reduction in the liver cirrhosis mortality rate, corresponding to 137 (95% CI: 61 – 212) less deaths. Interpretation: Taken together, our findings support the hypothesis that alcohol control policies that target alcohol pricing can have a significant, immediate effect on liver cirrhosis mortality at a population level in a high-income European country. These policy measures are simple, cost-effective, provide a high return on investment, and can complement individual-level interventions in reducing the burden of liver disease. Funding Information: Research reported in this publication was also supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIAAA). Declaration of Interests: The Authors declare that there are no conflicts of interest. Ethics Approval Statement: The Centre for Addiction and Mental Health Research Ethics Board (CAMH REB) has reviewed this study and has granted approval.