An evaluation of the impact of a large reduction in alcohol prices on alcohol-related and all-cause mortality: time series analysis of a population-based natural experiment

Abstract

Background: We examined the effect of a large reduction in the price of alcohol that occurred in Finland in 2004 on alcohol-related and all-cause mortality, and mortality due to cardiovascular diseases (CVDs) from which alcohol-attributable cases were excluded.

Methods: Time series intervention analysis modelling was applied to the monthly aggregations of deaths in Finland for the period 1996-2006 to assess the impact of the reduction in alcohol prices. Alcohol-related mortality was defined using information on both underlying and contributory causes of death. Analyses were carried out for men and women aged 15-39, 40-49, 50-69 and >69 years.

Results: Alcohol-related deaths increased in men aged 40-49 years, and in men and women aged 50-69 years, after the price reduction when trends and seasonal variation were taken into account: the mean rate of alcohol-related mortality increased by 17% [95% confidence interval (CI) 1.5, 33.7], 14% (95% CI 1.1, 28.0) and 40% (95% CI) 7.1, 81.7), respectively, which implies 2.5, 2.9 and 1.6 additional monthly deaths per 100,000 person-years following the price reduction. In contrast to alcohol-related mortality, CVD and all-cause mortality decreased: among men and women aged >69 years a decrease of 7 and 10%, respectively, in CVD mortality implied 19 and 25 fewer monthly deaths per 100,000 person-years, and a decrease of 7 and 14%, respectively, in all-cause mortality similarly implied 42 and 69 fewer monthly deaths.

Conclusion: These results obtained from the time series analyses suggest that the reduction in alcohol prices led to an increase in alcohol-related mortality, except in persons <40 years of age. However, it appears that beneficial effects in older age, when CVD deaths are prevalent, counter-balance these adverse effects, at least to some extent.

Figure 1

Monthly alcohol-related mortality rates per 100 000 person-years among men (solid line) and women (dashed line), aged 15–39, 40–49, 50–69 and >69 years, Finland, 1996–2006. The vertical line indicates the realization of the reduction in alcohol prices on 1 March 2004

Figure 2

Monthly rates of CVD mortality per 100 000 person-years among men (solid line) and women (dashed line), aged 15–39, 40–49, 50–69 and >69 years, Finland, 1996–2006. The vertical line indicates the realization of the reduction in alcohol prices on 1 March 2004

Figure 3

Monthly all-cause mortality rates per 100 000 person-years among men (solid line) and women (dashed line), aged 15–39, 40–49, 50–69 and >69 years, Finland, 1996–2006. The vertical line indicates the realization of the reduction in alcohol prices on 1 March 2004