Evaluation of the impact of alcohol control policies on morbidity and mortality in Lithuania and other Baltic states

Alcohol use has been identified as a major risk factor for the global burden of mortality and morbidity. Due to the overall high level of alcohol use, combined with a high prevalence of irregular binge-drinking patterns, Eastern Europe was found to be one of the regions with the highest burden of alcohol-attributable disease and mortality globally.

Consequently over the last decade, a number of alcohol policies recommended as part of WHO’s “best buys”, policies that are effective and cost-effective, have been implemented in Lithuania.

The aim of the current project, funded by NIAAA (grant no. 1R01AA028224) is to evaluate the effect of these policies across a variety of outcomes including and not limited to mortality and morbidity, alcohol-related harm, alcohol consumption, and economic costs. In addition, we aim to compare the temporal trends and changes in these outcome measures to other neighbouring Baltic states.

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Vaitkevičiūtė, J., Gobiņa, I., Janik-Koncewicz, K., Lange, S., Miščikienė, L., Petkevičienė, J., ... & Jiang, H. (2023). Alcohol control policies reduce all-cause mortality in Baltic Countries and Poland between 2001 and 2020. Scientific Reports, 13(1), 6326.

Štelemėkas, M., Manthey, J., Badaras, R., Casswell, S., Ferreira‐Borges, C., Kalėdienė, R., ... & Rehm, J. (2021). Alcohol control policy measures and all‐cause mortality in Lithuania: an interrupted time–series analysis. Addiction, 116(10), 2673-2684.

The co-PIs of the project are preeminent researchers in the Baltic countries, who had access to high quality data on individual causes of death. Using monthly mortality data from multiple comparable countries allowed the team to carefully analyze the temporal trends in mortality and the impact of various factors (e.g., policy changes, sociocultural differences, economic events) on these trends.

Furthermore, the results of these analyses are generalizable to other regions, as they were conducted on high-income EU countries. With such a precise scale of data, the team has been able to rigorously test the impact of alcohol control policies on all-cause mortality, and other cause-specific mortality rates as well (e.g., suicide, liver cirrhosis, homicide rates, traffic injuries).

Consistently across our published studies, alcohol pricing (i.e., taxation) has emerged as an effective policy that not only predicts reductions in the above mentioned causes of death, but more importantly, predicts reductions in alcohol consumption per capita.

As demonstrated in this figure, the scaled increases in taxation (shown in the black line) overlaps with years in which there were declines in alcohol consumption per capita. This effect of significantly increased taxation, leading to reduced APC was evident across the Baltic countries.

Rehm, J., Tran, A., Gobiņa, I., Janik-Koncewicz, K., Jiang, H., Kim, K. V., ... & Lange, S. (2022). Do alcohol control policies have the predicted effects on consumption? An analysis of the Baltic countries and Poland 2000–2020. Drug and Alcohol Dependence, 241, 109682.

In addition to the investigation of alcohol control policy effects on the epidemiology of disease, we conducted studies on real-world outcomes. In Lithuania, the co-Pis conducted a mystery shopper study, where researchers tested the enforcement of the recently increased minimum legal drinking age in Lithuania.

Another observational study conducted in Lithuania measured the prevalence of social media posts related to alcohol, in effect, testing the whether legislation that banned advertising and marketing of alcohol products was upheld by the alcohol industry.

Galkus, L., Lange, S., Liutkutė-Gumarov, V., Miščikienė, L., Petkevičienė, J., Rehm, J., ... & Vaitkevičiūtė, J. (2022). The comprehensive alcohol advertising ban in Lithuania: a case study of social media. International Journal of Environmental Research and Public Health, 19(19), 12398.

Miščikienė, L., Tran, A., Petkevičienė, J., Rehm, J., Vaitkevičiūtė, J., Galkus, L., ... & Štelemėkas, M. (2023). A mystery-shopping study to test enforcement of minimum legal purchasing age in Lithuania in 2022. European Journal of Public Health, 33(2), 317-322.

The project will continue to run until March of 2025, with a recent supplement received that will focus on understanding the impact of COVID-19 on alcohol consumption patterns in different populations and on the same alcohol-attributable disease outcomes.