Simulation of Alcohol Control Policies for Health Equity (SIMAH) Project: Study Design and First Results

Abstract

Since about 2010, life expectancy at birth in the United States has stagnated and begun to decline, with concurrent increases in the socioeconomic divide in life expectancy. The Simulation of Alcohol Control Policies for Health Equity (SIMAH) Project uses a novel microsimulation approach to investigate the extent to which alcohol use, socioeconomic status (SES), and race/ethnicity contribute to unequal developments in US life expectancy and how alcohol control interventions could reduce such inequalities. Representative, secondary data from several sources will be integrated into one coherent, dynamic microsimulation to model life-course changes in SES and alcohol use and cause-specific mortality attributable to alcohol use by SES, race/ethnicity, age, and sex. Markov models will be used to inform transition intensities between levels of SES and drinking patterns. The model will be used to compare a baseline scenario with multiple counterfactual intervention scenarios. The preliminary results indicate that the crucial microsimulation component provides a good fit to observed demographic changes in the population, providing a robust baseline model for further simulation work. By demonstrating the feasibility of this novel approach, the SIMAH Project promises to offer superior integration of relevant empirical evidence to inform public health policy for a more equitable future.

Keywords: alcohol policy; alcohol use; health equity; health policy; life expectancy; microsimulation; population health modeling; socioeconomic status.

Figure 1

Study design, analysis steps, and data sources used in the Simulation of Alcohol Control Policies for Health Equity (SIMAH) Project. ACS, American Community Survey; APIS, Alcohol Policy Information System; BRFSS, Behavioral Risk Factor Surveillance System; NESARC, National Epidemiologic Survey on Alcohol and Related Conditions; PSID, Panel Study of Income Dynamics; SES, socioeconomic status; YLL, years of potential life lost.

Figure 2

Prevalence of alcohol consumption in 4 categories among men (top row) and women (bottom row) in the baseline synthetic population and in Behavioral Risk Factor Surveillance System (BRFSS) data, by educational attainment in 2000, Simulation of Alcohol Control Policies for Health Equity (SIMAH) Project. Category 1: ≤20/≤40 (women/men) g/day; category 2: 21–40/41–60 (women/men) g/day; category 3: 41–60/61–100 (women/men) g/day; category 4: >60/>100 (women/men) g/day.

Figure 3

Distributions of men (top row) and women (bottom row) by educational level as an indicator of socioeconomic status over time, modeled via microsimulation (2000–2018), as compared with the US Census (2000, 2010), the American Community Survey (ACS; annual data from 2000–2018), and the Panel Study of Income Dynamics (PSID; biannual data from 1999–2017), Simulation of Alcohol Control Policies for Health Equity (SIMAH) Project. Gray shaded areas with dashed lines indicate 95% uncertainty intervals.

Figure 4

Continues

Figure 4

Age-standardized mortality rates per 100,000 population for 9 cause-of-death categories between 2000 and 2018 as observed (target data; dotted line) and as modeled by microsimulation (solid line), by sex (black, men; gray, women) and educational level (an indicator of socioeconomic status), Simulation of Alcohol Control Policies for Health Equity (SIMAH) Project. Results were age-standardized to the US population in 2018. Panels A–C, alcohol use disorders; panels D–F, hypertensive heart disease; panels G–I, stroke; panels J–L, liver cirrhosis; panels M–O, suicide; panels P–R, other unintentional injury; panels S–U, motor vehicle accidents; panels V–X, diabetes; panels Y–ZB, ischemic heart disease. “Stroke” represents ischemic stroke; “liver cirrhosis” includes liver disease and cirrhosis.

Figure 5

Lessons learned from the Simulation of Alcohol Control Policies for Health Equity (SIMAH) Project.