Mindaugas Štelemėkas1,2, Jakob Manthey3,4,5, Robertas Badaras6,7, Sally Casswell8, Carina Ferreira-Borges9, Ramunė Kalėdienė10, Shannon Lange11, Maria Neufeld3,9,11, Janina Petkevičienė1,2, Ričardas Radišauskas12,13, Robin Room14,15, Tadas Telksnys1, Ingrida Zurlytė16, Jürgen Rehm3,4,11,17,18,19,20,21. 1. Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania. 2. Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania. 3. Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany. 4. Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany. 5. Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany. 6. Clinic of Anaesthesiology and Intensive Care, Faculty of Medicine, Centre of Toxicology, Vilnius University, Vilnius, Lithuania. 7. Vilnius University Emergency Hospital, Vilnius, Lithuania. 8. SHORE and Whariki Research Centre, College of Health, Massey University, New Zealand. 9. WHO European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Russia. 10. Department of Health Management, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania. 11. Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada. 12. Department of Environmental and Occupational Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania. 13. Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania. 14. Centre for Alcohol Policy Research, La Trobe University, Bundoora, VIC, Australia. 15. Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden. 16. WHO Country Office Lithuania, Vilnius, Lithuania. 17. Department of Psychiatry, University of Toronto, Toronto, ON, Canada. 18. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. 19. Institute of Medical Science, University of Toronto, Toronto, ON, Canada. 20. Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada. 21. Department of International Health Projects, Institute for Leadership and Health Management, I. M. Sechenov First Moscow State Medical University, Moscow, Russia.
Abstract
BACKGROUND AND AIMS: Alcohol use has been identified as a major risk factor for burden of mortality and disease, particularly for countries in eastern Europe. During the past two decades, several countries in this region have implemented effective alcohol policy measures to combat this burden. The aim of the current study was to measure the association between Lithuania's alcohol control policies and adult all-cause mortality. DESIGN: Interrupted time-series methodology by means of general additive models. SETTING: Lithuania. PARTICIPANTS: Adult population of Lithuania, aged 20 years and older. MEASUREMENTS: Alcohol control policies were ascertained via a document review of relevant legislation materials. Policy effects were evaluated as follows: (1) slope changes in periods of legislative (non-)activity with regard to alcohol control policy (analysis 1); (2) level changes of three interventions following recommendations of the World Health Organization (analysis 2); and (3) level changes of seven interventions judged a priori by an international panel of experts (analysis 3). Mortality was measured by sex-stratified and total monthly age-standardized rates of all-cause mortality for the adult population. FINDINGS: During the period 2001-18, effective alcohol control policy measures were implemented on several occasions, and in those years the all-cause mortality rate declined by approximately 3.2% more than in years without such policies. In particular, the implementation of increased taxation in 2017 was associated with reduced mortality over and above the general trend for men and in total for all analyses, which amounted to 1452 deaths avoided (95% confidence interval = -166 to -2739) in the year following the implementation of the policy. CONCLUSIONS: Alcohol control policies in Lithuania appear to have reduced the overall adult all-cause mortality over and above secular trends.
BACKGROUND AND AIMS: Alcohol use has been identified as a major risk factor for burden of mortality and disease, particularly for countries in eastern Europe. During the past two decades, several countries in this region have implemented effective alcohol policy measures to combat this burden. The aim of the current study was to measure the association between Lithuania's alcohol control policies and adult all-cause mortality. DESIGN: Interrupted time-series methodology by means of general additive models. SETTING: Lithuania. PARTICIPANTS: Adult population of Lithuania, aged 20 years and older. MEASUREMENTS: Alcohol control policies were ascertained via a document review of relevant legislation materials. Policy effects were evaluated as follows: (1) slope changes in periods of legislative (non-)activity with regard to alcohol control policy (analysis 1); (2) level changes of three interventions following recommendations of the World Health Organization (analysis 2); and (3) level changes of seven interventions judged a priori by an international panel of experts (analysis 3). Mortality was measured by sex-stratified and total monthly age-standardized rates of all-cause mortality for the adult population. FINDINGS: During the period 2001-18, effective alcohol control policy measures were implemented on several occasions, and in those years the all-cause mortality rate declined by approximately 3.2% more than in years without such policies. In particular, the implementation of increased taxation in 2017 was associated with reduced mortality over and above the general trend for men and in total for all analyses, which amounted to 1452 deaths avoided (95% confidence interval = -166 to -2739) in the year following the implementation of the policy. CONCLUSIONS: Alcohol control policies in Lithuania appear to have reduced the overall adult all-cause mortality over and above secular trends.
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