Impact of Minimum Unit Pricing on Alcohol-Related Emergency Department Attendances in Scotland: A Natural Experiment Study

Vivian So,Gerry Mccartney,Allison Ford,Srinivasa Vittal Katikireddi,Michele Open,Douglas Eadie,Lesley Graham,Colin Drummond,Ross Forsyth,Lynn Owens,Anne Ludbrook,Paolo Deluca,Samantha Perry,Chris Yap,Shona Hilton,Lyndal Bond,Martine Stead,Andrew Millard ,Niamh Fitzgerald ,Oarabile R Molaodi ,T J Phillips ,Alastair H Leyland

doi:10.2139/ssrn.3697993

Abstract

Background: Minimum Unit Pricing (MUP) was introduced in Scotland at 50p per unit (8g) of alcohol on 1st May 2018 to reduce alcohol consumption and associated harms. We assessed its impact on alcohol-related emergency department (ED) attendances, drinking patterns, and having an alcohol-related diagnosis amongst ED attendees. Methods: We used a natural experiment approach to compare outcomes between Scotland (intervention group) and England (comparison group). Two EDs in Scotland and two in England were recruited for one baseline and two post-intervention waves. Research nurses considered all attendees for interview, and recorded reasons for not interviewing attendees. The primary outcome was alcohol-related attendances among all recorded attendees. Secondary outcomes included alcohol-related diagnosis, binge drinking and high-risk drinking, and tested for differential effects across socioeconomic groups. Difference-in-difference regression models adjusted for age, sex and baseline covariates. Findings: 12,207 participants were recruited in Scotland and 11,248 in England. The odds ratio for an alcohol-related attendance was 1.14 (95% CI 0.90-1.44) after the introduction of MUP in Scotland relative to England, after controlling for covariates. It is estimated that an additional 1.0% (95% CI -0.7% to 2.7%) of the ED attendances were alcohol-related than would have been the case in the absence of MUP. Meanwhile, the odds for an attendee having at least one alcohol-related diagnosis increased after MUP (OR=1.25, 95%CI 1.00-1.57). There was no evidence of substantive differences in the majority of other secondary outcomes after the introduction of MUP in Scotland, or of differential effects across socioeconomic groups. Interpretation: We found no evidence that MUP impacted on alcohol-related ED attendances.

Highlights

Alcohol accounts for 2.8 million deaths every year, approximately 10% of all deaths worldwide 2016.1 Alcohol misuse affects public health, and contributes to socioeconomic inequalities in health
We examined the impact of Minimum Unit Pricing (MUP) on alcohol-related emergency department (ED) visits and alcohol-related diagnosis among attendees
Our results showed that MUP was only marginally associated with alcohol-related diagnosis and there was no evidence that MUP had any effect on primary and other secondary outcomes

Summary

Introduction

Alcohol accounts for 2.8 million deaths every year, approximately 10% of all deaths worldwide 2016.1 Alcohol misuse affects public health, and contributes to socioeconomic inequalities in health. The Scottish Government has been implementing a range of strategies to reduce alcohol consumption, alcohol-related harms, and health inequalities.. Minimum Unit Pricing (MUP) of alcohol was an innovative and highprofile component of a comprehensive alcohol strategy. There is considerable evidence of an inverse alcohol price-consumption relationship.. There is considerable evidence of an inverse alcohol price-consumption relationship.5-7 These studies show that pricing policies are one of the most effective strategies to reduce alcohol consumption and the associated health harms.. Data modelling suggested that MUP would be an effective policy for reducing alcohol consumption and associated health harms. . Health inequalities are likely to be reduced by the introduction of MUP. Minimum Unit Pricing (MUP) was introduced in Scotland at 50p per unit (8g) of alcohol on 1st May 2018 to reduce alcohol consumption and associated harms.

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