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. 2022 Apr;42(4):765-774.
doi: 10.1111/liv.15151. Epub 2022 Jan 30.

Can alcohol control policies reduce cirrhosis mortality? An interrupted time-series analysis in Lithuania

Alexander Tran  1 , Huan Jiang  1   2 , Shannon Lange  1   3   4 , Jakob Manthey  5   6   7 , Mindaugas Štelemėkas  8   9 , Robertas Badaras  1   3   10   11 , Janina Petkevičienė  8   9 , Ričardas Radišauskas  12   13 , Robin Room  14   15 , Jürgen Rehm  1   2   4   5   6   16   17
Affiliations

Can alcohol control policies reduce cirrhosis mortality? An interrupted time-series analysis in Lithuania

Alexander Tran et al. Liver Int. 2022 Apr.

Abstract

Background and aims: The relationship between alcohol consumption and cirrhosis is well established. Policies that can influence population-level use of alcohol should, in turn, impact cirrhosis. We examined the effect of population-level alcohol control policies on cirrhosis mortality rates in Lithuania - a high-income European Union country with high levels of alcohol consumption.

Methods: Age-standardized, monthly liver mortality data (deaths per 100,000 adults, aged 15+) from Lithuania were analysed from 2001 to 2018 (n = 216 months) while controlling for economic confounders (gross domestic product and inflation). An interrupted time-series analysis was conducted to estimate the effect of three alcohol control policies implemented in 2008, 2017 and 2018 and the number of cirrhosis deaths averted.

Results: There was a significant effect of the 2008 (P < .0001) and 2017 (P = .0003) alcohol control policies but a null effect of the 2018 policy (P = .40). Following the 2008 policy, the cirrhosis mortality rate dropped from 4.93 to 3.41 (95% CI: 3.02-3.80) deaths per 100,000 adults, which equated to 493 deaths averted. Further, we found that following the 2017 policy, the mortality rate dropped from 2.85 to 2.01 (95% CI: 1.50-2.52) deaths per 100,000 adults, corresponding to 245 deaths averted.

Conclusions: Our findings support the hypothesis that alcohol control policies can have a significant, immediate effect on cirrhosis mortality. These policy measures are cost-effective and aid in reducing the burden of liver disease.

Keywords: alcohol policy; alcohol-related liver disease; interrupted time-series analysis; population-level interventions.

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Conflict of interest statement

CONFLICT OF INTEREST

All authors declare no competing interests.

Figures

FIGURE 1
FIGURE 1
Distribution of mean monthly cirrhosis mortality rate (deaths per 100,000 adults) from 2001 to 2018, separated by 5-year age groups, and for both sexes combined
FIGURE 2
FIGURE 2
General additive mixed model (GAMM) of cirrhosis mortality rate (deaths per 100,000 adults, 15+ years of age), as predicted by GDP and inflation, and 3 policy effects with seasonality and ARIMA (auto-regressive, integrated moving average) terms (black line). Rates presented are for both sexes combined and are age-standardized according to the WHO standard, 95% Cis are also shown in light grey. Policy 1 and Policy 2 were significant (raw observed mortality rates (also age-standardized to WHO standard) of cirrhosis mortality rate (points))
FIGURE 3
FIGURE 3
Estimated number of cirrhosis deaths as predicted by the model (black) and as predicted by the counterfactual GAMM model (grey). Significant policies included Policy 1 in January 2008, and Policy 2 in March 2017, estimates were made for the 12-month period after the implementation of each policy, with 95% Cls. Estimated deaths averted were computed as the difference between the policy model and the counterfactual GAMM model: 493 deaths averted following Policy 1 and 245 deaths averted following Policy 2
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References

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