The impact of alcohol taxation increase on all-cause mortality inequalities in Lithuania: an interrupted time series analysis

TY - JOUR

T1 - The impact of alcohol taxation increase on all-cause mortality inequalities in Lithuania: an interrupted time series analysis

AU - Manthey, Jakob

AU - Jasilionis, Domantas

AU - Jiang, Huan

AU - Meščeriakova, Olga

AU - Petkevičienė, Janina

AU - Radišauskas, Ričardas

AU - Štelemėkas, Mindaugas

AU - Rehm, Jürgen

N1 - © 2023. The Author(s).

PY - 2023/1/16

Y1 - 2023/1/16

N2 - BACKGROUND: Taxation increases which reduce the affordability of alcohol are expected to reduce mortality inequalities. A recent taxation increase in Lithuania offers the unique possibility to test this hypothesis.METHODS: Census-linked mortality data between 2011 and 2019 were used to calculate monthly sex- and education-stratified age-standardized mortality rates for the population aged 40 to 70 years. As primary outcome, we analysed the difference in age-standardized all-cause mortality rates between the population of lowest versus highest educational achievement. The impact of the 2017 taxation increase was evaluated using interrupted time series analyses. To identify whether changes in alcohol use can explain the observed effects on all-cause mortality, the education-based mortality differences were then decomposed into n = 16 cause-of-death groupings.RESULTS: Between 2012 and 2019, education-based all-cause mortality inequalities in Lithuania declined by 18% among men and by 14% among women. Following the alcohol taxation increase, we found a pronounced yet temporary reduction of mortality inequalities among Lithuanian men (- 13%). Subsequent decomposition analyses suggest that the reduction in mortality inequalities between lower and higher educated men was mainly driven by narrowing mortality differences in injuries and infectious diseases.CONCLUSIONS: A marked increase in alcohol excise taxation was associated with a decrease in mortality inequalities among Lithuanian men. More pronounced reductions in deaths from injuries and infectious diseases among lower as compared to higher educated groups could be the result of differential changes in alcohol use in these populations.

AB - BACKGROUND: Taxation increases which reduce the affordability of alcohol are expected to reduce mortality inequalities. A recent taxation increase in Lithuania offers the unique possibility to test this hypothesis.METHODS: Census-linked mortality data between 2011 and 2019 were used to calculate monthly sex- and education-stratified age-standardized mortality rates for the population aged 40 to 70 years. As primary outcome, we analysed the difference in age-standardized all-cause mortality rates between the population of lowest versus highest educational achievement. The impact of the 2017 taxation increase was evaluated using interrupted time series analyses. To identify whether changes in alcohol use can explain the observed effects on all-cause mortality, the education-based mortality differences were then decomposed into n = 16 cause-of-death groupings.RESULTS: Between 2012 and 2019, education-based all-cause mortality inequalities in Lithuania declined by 18% among men and by 14% among women. Following the alcohol taxation increase, we found a pronounced yet temporary reduction of mortality inequalities among Lithuanian men (- 13%). Subsequent decomposition analyses suggest that the reduction in mortality inequalities between lower and higher educated men was mainly driven by narrowing mortality differences in injuries and infectious diseases.CONCLUSIONS: A marked increase in alcohol excise taxation was associated with a decrease in mortality inequalities among Lithuanian men. More pronounced reductions in deaths from injuries and infectious diseases among lower as compared to higher educated groups could be the result of differential changes in alcohol use in these populations.

KW - Male

KW - Humans

KW - Female

KW - Lithuania/epidemiology

KW - Interrupted Time Series Analysis

KW - Cause of Death

KW - Ethanol

KW - Communicable Diseases

KW - Taxes

KW - Socioeconomic Factors

KW - Mortality

U2 - 10.1186/s12916-022-02721-6

DO - 10.1186/s12916-022-02721-6

M3 - SCORING: Journal article

C2 - 36647069

VL - 21

SP - 22

JO - BMC MED

JF - BMC MED

SN - 1741-7015

IS - 1

ER -