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Dadgar I, Norström T, Ramstedt M. Is there a link between per capita alcohol consumption and cancer mortality? Drug Alcohol Rev 2025; 44:411-423. [PMID: 39667722 DOI: 10.1111/dar.13984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 11/06/2024] [Accepted: 11/11/2024] [Indexed: 12/14/2024]
Abstract
INTRODUCTION A growing body of evidence has established alcohol consumption as a causative factor in an increasing array of cancer types, thereby positioning it as a leading global risk factor for cancer. Surprisingly, there is a scarcity of studies examining the extent to which shifts in population drinking affect cancer mortality, despite the substantial public health implications. This paper aims to: (i) estimate the impact of changes in per capita alcohol consumption on both overall cancer mortality rates and specific types of alcohol-related cancer; and (ii) assess whether the association between cancer and population alcohol consumption is influenced by a country's drinking patterns. METHODS We used time-series data for 19 high-income countries spanning the period 1960-2018. Cigarette sales and GDP per capita were included as control variables. The data were analysed using first-difference modelling. The World Health Organization drinking patterns score was used to evaluate a country's drinking pattern. RESULTS Our findings revealed that a 1 L per capita increase in alcohol consumption was associated with a 0.9% rise in total cancer mortality among women and a 1.1% increase among men. Notably, among men, the association was more pronounced for cancers with strong evidence of alcohol's effect and for prostate cancer. For women, the alcohol effect was statistically significant for breast cancer. Generally, the estimated alcohol effects were elevated in the country group with more harmful drinking patterns. DISCUSSION AND CONCLUSIONS Our results indicate that lowering per capita alcohol consumption is likely to reduce cancer mortality.
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Affiliation(s)
- Iman Dadgar
- Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
- Center for Educational Leadership and Excellence, Stockholm School of Economics, Stockholm, Sweden
- Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Thor Norström
- Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
| | - Mats Ramstedt
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Vaz K, Kemp W, Majeed A, Lubel J, Magliano DJ, Glenister KM, Bourke L, Simmons D, Roberts SK. Validation of serum non-invasive tests of liver fibrosis as prognostic markers of clinical outcomes in people with fatty liver disease in Australia. J Gastroenterol Hepatol 2025; 40:241-249. [PMID: 39444323 DOI: 10.1111/jgh.16774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 10/03/2024] [Accepted: 10/06/2024] [Indexed: 10/25/2024]
Abstract
BACKGROUND AND AIM The validity of non-invasive tests (NITs) of liver fibrosis for the prediction of liver and mortality outcomes in an Australian cohort is unknown. We aimed to verify the utility of available NITs to predict overall and cause-specific mortality and major adverse liver outcome (MALO). METHODS This was an analysis from the Crossroads 1 clinic sub-study of a randomly sampled adult cohort from regional Australia between 2001 and 2003. Baseline variables included demographic details, anthropometry, health and lifestyle data, and laboratory tests. Non-alcoholic fatty liver disease (NAFLD) and metabolic-(dysfunction) associated fatty liver disease (MAFLD) were defined by fatty liver index ≥ 60 and other accepted criteria. Outcomes were defined by the International Statistical Classification of Diseases and Related Health Problems 10th Revision codes for linked hospitalization and death registry data. Available serum-based NITs were analyzed as predictors of overall, cardiovascular disease-related, and cancer-related mortality and MALO in those with fatty liver disease (FLD). RESULTS In total, 1324 and 1444 participants were included for NAFLD and MAFLD analysis (prevalence 35.4% and 40.7%, respectively). There were 298 deaths (89 cardiovascular disease-related and 98 cancer-related) and 24 MALO over a median 19.7 years of follow-up time. In both forms of FLD, fibrosis-4 index, Steatosis-Associated Fibrosis Estimator score, and Forns fibrosis score consistently had the highest area under the receiver operating characteristic curve (AUROC) for overall and cause-specific mortality, with AUROC > 0.70 for each outcome. However, all had poor discriminatory ability for determining MALO in each FLD. CONCLUSIONS Several liver fibrosis NITs perform similarly reasonably well in predicting the risk of mortality outcomes in those with FLD but are poorly discriminatory for MALO prediction.
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Affiliation(s)
- Karl Vaz
- Department of Gastroenterology and Hepatology, Alfred Health, Melbourne, Australia
- The School of Translational Medicine (STM), Monash University, Melbourne, Australia
| | - William Kemp
- Department of Gastroenterology and Hepatology, Alfred Health, Melbourne, Australia
- The School of Translational Medicine (STM), Monash University, Melbourne, Australia
| | - Ammar Majeed
- Department of Gastroenterology and Hepatology, Alfred Health, Melbourne, Australia
- The School of Translational Medicine (STM), Monash University, Melbourne, Australia
| | - John Lubel
- Department of Gastroenterology and Hepatology, Alfred Health, Melbourne, Australia
- The School of Translational Medicine (STM), Monash University, Melbourne, Australia
| | - Dianna J Magliano
- Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Kristen M Glenister
- Department of Rural Health, The University of Melbourne, Melbourne, Australia
| | - Lisa Bourke
- Department of Rural Health, The University of Melbourne, Melbourne, Australia
| | - David Simmons
- Department of Rural Health, The University of Melbourne, Melbourne, Australia
- Macarthur Clinical School, School of Medicine, Western Sydney University, Melbourne, Australia
| | - Stuart K Roberts
- Department of Gastroenterology and Hepatology, Alfred Health, Melbourne, Australia
- The School of Translational Medicine (STM), Monash University, Melbourne, Australia
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Dunt DR, Jiang H, Room R. Early closing of hotels: Impacts on alcohol consumption, drunkenness, liver disease and injury mortality. Drug Alcohol Rev 2024; 43:491-500. [PMID: 38048172 DOI: 10.1111/dar.13780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 12/06/2023]
Abstract
INTRODUCTION Early (six o'clock) closing of hotels was introduced in 1916 in Australia to curb heavy drinking. It lasted between 21 and 51 years in four Australian states. The aim of this study is to assess the impact of early closing on alcohol consumption, liver disease mortality rates, drunkenness and various forms of injury. METHODS Time series analysis was undertaken using an Autoregressive Integrated Moving Averages modelling technique. Relevant data were derived from annual publications of the Australian Bureau of Statistics and its predecessor organisations. RESULTS Early closing had a substantial downward effect on alcohol consumption across 1901-2006. It had a substantial and beneficial effect on liver disease mortality. Drunkenness rates declined pre-World War II (WWII), though they increased post-WWII. Rates for homicide decreased substantially, and close to substantially for suicide and female homicide. Early closing impacts were more beneficial pre-WWII than post-WWII. DISCUSSION AND CONCLUSIONS Early closing has not been favourably remembered in Australia in recent years. However, all pre-WWII impacts of early closing were beneficial including public drunkenness rates. Post-WWII, beneficial effects were less clear-cut and drunkenness increased. Resistance to early closing may also have arisen in the 1950s as families had more disposable income and ability to consume alcohol. While universal six o'clock closing is no longer feasible or desirable, opening hours and days for hotels are still part of the policy discussion in Australia. The experience of early closing pre-WWII gives confidence that the impacts of these can be beneficial.
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Affiliation(s)
- David R Dunt
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Heng Jiang
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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Livingston M, Room R, Chikritzhs T, Taylor N, Yuen WS, Dietze P. Trends in alcohol-related liver disease mortality in Australia: An age-period-cohort perspective. Addiction 2023; 118:2156-2163. [PMID: 37349258 DOI: 10.1111/add.16275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/13/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND AND AIMS There have been few systematic attempts to examine how alcohol-related mortality has changed in Australia, and no studies that have explored cohort effects in alcohol-related mortality. This study uses more than 50 years of data to measure age, period and cohort trends in alcohol-related liver disease (ALD) mortality. DESIGN, SETTING AND CASES This was a retrospective age-period-cohort analysis of total Australian ALD mortality data from 1968 to 2020 in Australia. There was a total of 35 822 deaths-27 208 men (76%) and 8614 women (24%). MEASUREMENTS Deaths from ALD were grouped into 5-year age groups and periods (e.g. deaths for 20-24-year-olds between 1968 and 1972 were combined). FINDINGS ALD mortality peaked in the late 1970s and early 1980s for both men and women. In age-period-cohort models, mortality was highest for cohorts born 1915-30. For example, men born between 1923 and 1927 had a relative risk of 1.58 [95% confidence interval (CI) = 1.52, 1.64] compared with men born between 1948 and 1952. For women, there was an increase in risk for cohorts born in the 1960s [e.g. the 1963-67 cohort had a relative risk (RR) of 1.16 (95% CI = 1.07, 1.25) compared with women born in 1948-52]. For men, there was a broad decline in mortality over time [e.g. in 2020, the RR was 0.87 (95% CI = 0.82, 0.92) compared with the reference year of 2000]. For women, mortality declined until 2000 and has been stable since. CONCLUSIONS Alcohol-related liver disease mortality has declined across the Australian population since the 1970s and 1980s partly due to cohort-specific shifts as the highest-risk birth cohorts age. For women, this decline had stalled by the year 2000, and cohorts of women born during the 1960s were at higher risk than earlier cohorts, suggesting the need for thoughtful interventions as this population enters its highest-risk years for ALD mortality.
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Affiliation(s)
- Michael Livingston
- National Drug Research Institute, Curtin University, Perth, Australia
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
- Burnet Institute, Melbourne, Australia
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
- Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Tanya Chikritzhs
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Nicholas Taylor
- National Drug Research Institute, Curtin University, Perth, Australia
- Burnet Institute, Melbourne, Australia
- School of Psychology, Deakin University, Geelong, Australia
| | - Wing See Yuen
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | - Paul Dietze
- National Drug Research Institute, Curtin University, Perth, Australia
- Burnet Institute, Melbourne, Australia
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Tran A, Jiang H, Lange S, Manthey J, Štelemėkas M, Badaras R, Petkevičienė J, Radišauskas R, Room R, Rehm J. Can alcohol control policies reduce cirrhosis mortality? An interrupted time-series analysis in Lithuania. Liver Int 2022; 42:765-774. [PMID: 35023617 PMCID: PMC8930681 DOI: 10.1111/liv.15151] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/16/2021] [Accepted: 12/27/2021] [Indexed: 01/08/2023]
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.
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Affiliation(s)
- Alexander Tran
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Ontario, Canada
| | - Huan Jiang
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shannon Lange
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy & Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Mindaugas Štelemėkas
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Robertas Badaras
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada
- Clinic of Anaesthesiology and Intensive Care, Faculty of Medicine, Centre of Toxicology, Vilnius University, Vilnius, Lithuania
- Vilnius University Emergency Hospital, Vilnius, Lithuania
| | - Janina Petkevičienė
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ričardas Radišauskas
- Department of Environmental and Occupational Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Victoria, Australia
- Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Jürgen Rehm
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Clinical Psychology and Psychotherapy & Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Institute of Medical Science (IMS), University of Toronto, Medical Sciences Building, 1 King’s College Circle, Toronto, Ontario, Canada
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
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Raja SS, Batey RG, Edwards S, Aung HH. Standards of liver cirrhosis care in Central Australia. World J Hepatol 2022; 14:559-569. [PMID: 35582288 PMCID: PMC9055197 DOI: 10.4254/wjh.v14.i3.559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/04/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver cirrhosis and hepatocellular carcinoma (HCC) are highly prevalent in Australia’s Northern Territory. Contributing factors include high levels of alcohol consumption, viral hepatitis and metabolic syndrome. Rural Aboriginal residents form a significant proportion of the Central Australian population and present a challenge to traditional models of liver care. HCC surveillance and variceal screening are core components of liver cirrhosis management.
AIM To assess participation in HCC and variceal surveillance programmes in a Central Australian liver cirrhosis patient cohort.
METHODS Retrospective cohort study of patients with liver cirrhosis presenting to Alice Springs Hospital, Australia between January 1, 2012 and December 31, 2017. Demographic data, disease severity, attendance at hepatology clinics, participation in variceal and/or HCC surveillance programmes was recorded. Regression analyses were conducted to assess factors associated with two independent outcomes: Participation in HCC and variceal surveillance.
RESULTS Of 193 patients were identified. 82 patients (42.4%) were female. 154 patients (80%) identified as Aboriginal. Median Model for End-stage Liver Disease Score at diagnosis was 11. Alcohol was the most common cause of cirrhosis. Aboriginal patients were younger than non-Aboriginal patients (48.4 years vs 59.9 years, P < 0.001). There were similar rates of excess alcohol intake (72.6% vs 66.7%, P = 0.468) and obesity (34.5% vs 38.4%, P = 0.573 across non-Aboriginal and Aboriginal cohorts. 20.1% of patients took part in HCC surveillance and 42.1% of patients completed variceal screening. Aboriginal patients were less likely to engage with either HCC surveillance (OR: 0.38, 95%CI: 0.16-0.9, P = 0.025) or undergo variceal screening (OR: 0.31, 95%CI: 0.14-0.65, P = 0.002).
CONCLUSION HCC or variceal surveillance programmes had less uptake amongst Aboriginal patients. Greater emphasis needs to be placed on eliminating cultural obstacles to accessing hepatology services.
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Affiliation(s)
- Sreecanth S Raja
- Department of Gastroenterology, Alice Springs Hospital, Alice Springs 0870, Northern Territory, Australia
| | - Robert G Batey
- Department of Medicine, Alice Springs Hospital, Alice Springs 0870, Northern Territory, Australia
| | - Suzanne Edwards
- Department of Statistician, School of Public Health, University of Adelaide, Adelaide 5000, South Australia, Australia
| | - Hein H Aung
- Department of Medicine, Alice Springs Hospital, Alice Springs 0870, Northern Territory, Australia
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A time-series analysis of the association between alcohol and suicide in Australia. Drug Alcohol Depend 2022; 231:109203. [PMID: 34954450 DOI: 10.1016/j.drugalcdep.2021.109203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION 800,000 people die by suicide every year according to World Health Organisation data. Studies have shown associations between alcohol consumption and suicide, with most demonstrating that alcohol consumption increases suicide risk. However, some studies from high consumption countries show results in the opposite direction. This present study examines the association between per capita (PC) alcohol consumption and same year suicide mortality in Australia, and tests for lag effects, between 1910 and 2017. MATERIALS AND METHODS Age and gender-specific autoregressive integrated moving average (ARIMA) models were used to examine associations between alcohol consumption PC and suicide mortality rates. Associations between unemployment, divorce, barbiturates access, and the Great Depression and World War II, and suicide were examined. RESULTS A 10% increase in PC alcohol consumption was associated with a 5% and 5.1% decrease in overall and male suicide mortality respectively in the same year. However, a 10% increase in PC alcohol consumption was associated with an 5.1% and 5.4% increase in overall and male suicide mortality respectively 12 years later. This association differed among age groups and was significant in the male population only. Unemployment, divorce, the Great Depression and WW2, and barbiturates access were significantly associated with same year suicide mortality. DISCUSSION Contemporaneous alcohol consumption was associated with decreased suicide mortality, but was also associated with an increased risk of suicide 12 years later. Unemployment and barbiturates access were associated with an increased risk of suicide. Interventions and policies that address chronic alcohol consumption and support the unemployed may reduce suicide mortality.
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Holmes J, Ally AK, Meier PS, Pryce R. The collectivity of British alcohol consumption trends across different temporal processes: a quantile age-period-cohort analysis. Addiction 2019; 114:1970-1980. [PMID: 31325193 DOI: 10.1111/add.14754] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/16/2019] [Accepted: 07/15/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND AIMS UK alcohol consumption per capita has fallen by 18% since 2004, while the alcohol-specific death rate has risen by 6%. Inconsistent consumption trends across the population may explain this. Drawing on the theory of the collectivity of drinking cultures and age-period-cohort analyses, we tested whether consumption trends are consistent across lighter and heavier drinkers for three temporal processes: (i) the life-course, (ii) calendar time and (iii) successive birth cohorts. DESIGN Sex-specific quantile age-period-cohort regressions using repeat cross-sectional survey data. SETTING Great Britain, 1984-2011. PARTICIPANTS Adult (18+) drinkers responding to 17 waves of the General Lifestyle Survey (total n = 175 986). MEASUREMENTS Dependent variables: the 10th, 25th, 50th, 75th, 90th, 95th and 99th quantiles of the logged weekly alcohol consumption distribution (excluding abstainers). INDEPENDENT VARIABLES seven age groups (18-24, 25-34… 65-74, 75+ years), five time-periods (1984-88… 2002-06, 2008-11) and 16 five-year birth cohorts (1915-19… 1990-94). Additional control variables: ethnicity and UK country. FINDINGS Within age, period and cohort trends, changes in consumption were not consistently in the same direction at different quantiles of the consumption distribution. When they were, the scale of change sometimes differed between quantiles. For example, between 1996-2000 and 2008-2011, consumption among women decreased by 18% [95% confidence interval (CI) = -32 to -2%] at the 10th quantile but increased by 11% (95% CI = 2-21%) at the median and by 28% (95% CI = 19-38%) at the 99th quantile, implying that consumption fell among lighter drinkers and rose among heavier drinkers. This type of polarized trend also occurred between 1984-88 and 1996-2000 for men and women. Age trends showed collectivity, but cohort trends showed a mixture of collectivity and polarization. CONCLUSIONS Countervailing alcohol consumption and alcohol-related harm trends in the United Kingdom may be explained by lighter and heavier drinkers having different period and cohort trends, as well as by the presence of cohort trends that mean consumption may rise in some age groups while falling in others.
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Affiliation(s)
- John Holmes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Abdallah K Ally
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Petra S Meier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Robert Pryce
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Li YM, Fan JG. Guidelines of prevention and treatment for alcoholic liver disease (2018, China). J Dig Dis 2019; 20:174-180. [PMID: 30450822 DOI: 10.1111/1751-2980.12687] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 12/11/2022]
Affiliation(s)
- You Ming Li
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Jian Gao Fan
- Department of Gastroenterology, XinHua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Children's Digestion and Nutrition, Shanghai, China
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10
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Abstract
This Review presents current epidemiological trends of the most common liver diseases in Asia-Pacific countries. Hepatitis B virus (HBV) remains the primary cause of cirrhosis; despite declining prevalence in most Asian nations, this virus still poses a severe threat in some territories and regions. Mortality resulting from HBV infection is declining as a result of preventive measures and antiviral treatments. The epidemiological transition of hepatitis C virus (HCV) infection has varied in the region in the past few decades, but the medical burden of infection and the prevalence of its related cancers are increasing. The lack of licensed HCV vaccines highlights the need for novel treatment strategies. The prevalence of nonalcoholic fatty liver disease (NAFLD) has risen in the past decade, mostly owing to increasingly urbanized lifestyles and dietary changes. Alternative herbal medicine and dietary supplements are major causes of drug-induced liver injury (DILI) in some countries. Complications arising from these chronic liver diseases, including cirrhosis and liver cancer, are therefore emerging threats in the Asia-Pacific region. Key strategies to control these liver diseases include monitoring of at-risk populations, implementation of national guidelines and increasing public and physician awareness, in concert with improving access to health care.
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11
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Furr-Holden CDM, Nesoff ED, Nelson V, Milam AJ, Smart M, Lacey K, Thorpe RJ, Leaf PJ. Understanding the relationship between alcohol outlet density and life expectancy in Baltimore City: The role of community violence and community disadvantage. JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 47:63-75. [PMID: 30506926 PMCID: PMC6287269 DOI: 10.1002/jcop.22099] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 04/14/2018] [Accepted: 04/18/2018] [Indexed: 05/29/2023]
Abstract
This research investigated the relationship between alcohol outlet density (AOD) and life expectancy, as mediated by community violence and community disadvantage. We used linear regression models to assess bivariate and multivariate relationships. There was a negative bivariate association between liquor store density and average life expectancy (β = -7.3370, p < 0.001). This relationship was partially attenuated when controlling for community disadvantage and fully attenuated when controlling for community violence. Bars/taverns (i.e., on-premise) were not associated with average life expectancy (β = -0.589, p = 0.220). Liquor store density is associated with higher levels of community disadvantage and higher rates of violence, both of which are associated with lower life expectancies. Future research, potential intervention, and current related policies are discussed.
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Affiliation(s)
| | | | | | | | | | - Krim Lacey
- Michigan State University
- University of Michigan-Dearborn
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12
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Stanesby O, Jayasekara H, Callinan S, Room R, English D, Giles GG, MacInnis RJ, Milne RL, Livingston M. Women's role in the rise in drinking in Australia 1950-80: an age-period-cohort analysis of data from the Melbourne Collaborative Cohort Study. Addiction 2018; 113:2194-2202. [PMID: 29974540 DOI: 10.1111/add.14377] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/10/2018] [Accepted: 06/27/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIMS In Australia, as in many countries, alcohol consumption increased dramatically during the second half of the 20th century, with increased availability of alcohol, relaxation of attitudes towards drinking and shifting roles and opportunities for women as facilitating factors. We sought to investigate drinking trends by gender and birth cohort in Australia during this period. DESIGN Retrospective cohort study. SETTING, PARTICIPANTS AND MEASUREMENTS Using the usual frequency and quantity of beverage-specific alcohol intake for 10-year periods from age 20, reported retrospectively from 40 789 participants aged 40-69 years (born 1920-49) at recruitment to the Melbourne Collaborative Cohort Study in 1990-94, we compared trends in alcohol consumption by sex in Australia between 1950 and 1990. Participants' average daily consumption for age decades were transformed to estimated intakes for 1950, 1960, 1970, 1980 and 1990. FINDINGS Alcohol consumption was higher for men than women during each decade. Alcohol consumption increased for both sexes in the 1950s, 1960s and 1970s, and fell after 1980. The rise before 1980 was roughly equal in absolute terms for both sexes, but much greater relative to 1950 for women. Women born during 1930-39 and 1940-49 drank more alcohol during early-middle adulthood (ages 20-40) than women born during 1920-29. In the 1980s, the fall was greater in absolute terms for men, but roughly equal relative to 1950 for both sexes. In both sexes, the decline in drinking in the 1980s for birth-decade cohorts was roughly in parallel. CONCLUSIONS Specific birth cohorts were influential in the rise in alcohol consumption by Australian women born in 1920-49 after World War II. Much of the convergence with men's drinking after 1980 reflects large reductions in drinking among men.
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Affiliation(s)
- Oliver Stanesby
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Harindra Jayasekara
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia
| | - Sarah Callinan
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
| | - Dallas English
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Graham G Giles
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Robert J MacInnis
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Roger L Milne
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Michael Livingston
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,CAN (Swedish Council for Information on Alcohol and Other Drugs), Stockholm, Sweden
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13
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Jiang H, Livingston M, Room R, Chenhall R, English DR. Temporal Associations of Alcohol and Tobacco Consumption With Cancer Mortality. JAMA Netw Open 2018; 1:e180713. [PMID: 30646024 PMCID: PMC6324312 DOI: 10.1001/jamanetworkopen.2018.0713] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE Understanding whether the population-level consumption of alcohol and tobacco is associated with cancer mortality is a crucial question for public health policy that has not been answered by previous studies. OBJECTIVE To examine temporal associations of alcohol and tobacco consumption with overall cancer mortality in the Australian population, looking across different sex and age groups. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study conducted a time series analysis (autoregressive integrated moving average models) using aggregate-level annual time series data from multiple sources. Data on alcohol consumption and tobacco consumption per capita between 1935 and 2014 among the Australian population aged 15 years and older were collected from the Australian Bureau of Statistics and Cancer Council Victoria. Analysis was conducted from June 1, 2017, to October 30, 2017. EXPOSURES Sex- and age-specific cancer mortality rates from 1968 to 2014 were collected from the Australian Institute Health and Welfare. MAIN OUTCOMES AND MEASURES Population-level cancer mortality in different sex and age groups in Australia, controlling for the effects of health expenditure. RESULTS Among the Australian total population aged 15 years and older in this study, 50.5% were women. Cancer death rates per 100 000 persons increased from 199 in 1968 to 214 in 1989 and then decreased steadily to 162 in 2014. Taking into account lagged effects, 1-L decreases in alcohol consumption per capita were associated with a decline of 3.9% in overall cancer mortality over a 20-year period, and 1-kg decreases in tobacco consumption per capita were associated with a 16% reduction. Alcohol consumption per capita was significantly associated with overall cancer mortality among men aged 50 to 69 years and women aged 50 years and older. Tobacco consumption per capita was found to be significantly associated with overall cancer mortality only among men aged 50 years and older. CONCLUSIONS AND RELEVANCE In this study, alcohol consumption per capita was positively associated with overall cancer mortality among older men and women, and tobacco consumption per capita was positively associated with overall cancer mortality among older men over a 20-year period. This study provides evidence that a decrease in population-level drinking and tobacco smoking could lead to a reduction in cancer mortality.
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Affiliation(s)
- Heng Jiang
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Livingston
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Robin Room
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
| | - Richard Chenhall
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dallas R. English
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
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14
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Jiang H, Livingston M, Room R. Alcohol consumption and fatal injuries in Australia before and after major traffic safety initiatives: a time series analysis. Alcohol Clin Exp Res 2016; 39:175-83. [PMID: 25623416 DOI: 10.1111/acer.12609] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 10/20/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND The associations between population-level alcohol consumption and fatal injuries have been examined in a number of previous studies, but few have considered the external impacts of major policy interventions. This study aims to quantify the associations between per capita alcohol consumption and traffic and nontraffic injury mortality rates in Australia before and after major traffic safety initiatives (the introduction of compulsory seat belt legislation [CSBL] and random breath testing [RBT] in 1970s). METHODS Using data from 1924 to 2006, gender- and age-specific traffic and nontraffic mortality rates (15 years and above) were analyzed in relation to per capita alcohol consumption using time series analysis. The external effects of policy interventions were measured by inserting a dummy variable in the time series models. RESULTS Statistically significant associations between per capita alcohol consumption and both types of fatal injuries were found for both males and females. The results suggest that an increase in per capita alcohol consumption of 1 l was accompanied by an increase in traffic mortality of 3.4 among males and 0.5 among females per 100,000 inhabitants and an increase in nontraffic mortality of 3.0 among males and 0.9 among females. The associations between alcohol consumption and fatal injury rates varied across age groups. The introduction of CSBL and RBT was associated with significant reductions in traffic crash mortality in Australia, particularly for males and young people. CONCLUSIONS The magnitude and distribution of the preventive effects from the reduction in population drinking on fatal injuries vary across different gender and age groups, with the strongest preventive impacts on fatal injuries among people aged 15 to 29 and 70 years and above. The mechanisms behind these effects are unclear from this study, but are likely to be due to the strong association between per capita consumption and heavy drinking.
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Affiliation(s)
- Heng Jiang
- Centre for Alcohol Policy Research, Turning Point, Fitzroy, Victoria, Australia; Eastern Health Clinical School, Monash University, Victoria, Australia
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15
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Howell J, Balderson G, Hellard M, Gow P, Strasser S, Stuart K, Wigg A, Jeffrey G, Gane E, Angus PW. The increasing burden of potentially preventable liver disease among adult liver transplant recipients: A comparative analysis of liver transplant indication by era in Australia and New Zealand. J Gastroenterol Hepatol 2016; 31:434-41. [PMID: 26251217 DOI: 10.1111/jgh.13082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 07/20/2015] [Accepted: 07/26/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hepatitis C (HCV), hepatitis B (HBV), alcohol-related liver disease (ALD), and non-alcohol-related fatty liver disease (NAFLD) are leading indications for adult liver transplantation in Australia and New Zealand. However, these diseases are potentially preventable through effective primary and/or secondary prevention strategies. This study evaluates the relative contribution of potentially preventable liver diseases to liver transplant numbers in Australia and New Zealand over time. METHODS Prospectively recorded clinical, demographic, and outcome data were collected from the Australian and New Zealand Liver Transplant Registry for all primary adult liver transplants performed in Australia and New Zealand from 1 January 1985 until 31 December 2012. Potentially preventable liver disease was defined as HBV, HCV, NAFLD, ALD, and HCC. The etiology of liver disease leading to liver transplantation and the proportion of preventable liver disease-related liver transplantation was compared between Era 1 (1985-1993), Era 2 (1994-2003), and Era 3 (2004-2012). RESULTS Overall, 1252 of 3266 adult primary liver transplants (38.3%) were performed for potentially preventable liver disease. There was a significant increase in the proportion of liver transplants because of preventable liver disease from 21.2% (93 of 439) in Era 1, to 49.8% (623 of 1252) in Era 2 and 63.5% (1000 of 1575) in Era 3 (P < 0.0001). Over time, there was a significant increase in HCV (P < 0.0001), ALD (P = 0.002), and NAFLD (P < 0.0001) as a primary indication for adult liver transplant, whereas HBV has significantly decreased from Era 1 to Era 3 as an indication for transplant (P < 0.0001). The number of transplants performed for HCC also increased across Eras (P < 0.0001), with 84% due to underlying potentially preventable liver disease. CONCLUSION Since 2004, the majority of primary adult liver transplants within Australia and New Zealand have been because of potentially preventable liver diseases and the prevalence of these diseases has increased over time. This finding represents an opportunity for clinicians to make a significant impact on the overall burden of advanced liver disease in Australia and New Zealand by improving primary and secondary prevention measures.
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Affiliation(s)
- Jessica Howell
- Liver Transplant Unit, Austin Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia.,Centre for Population Health, MacFarlane-Burnet Institute, Melbourne, Australia.,Department of Medicine, Imperial College, London, UK
| | - Glenda Balderson
- Australia and New Zealand Liver Transplant Registry, Princess Alexandra Hospital, Brisbane, Australia
| | - Margaret Hellard
- Centre for Population Health, MacFarlane-Burnet Institute, Melbourne, Australia
| | - Paul Gow
- Liver Transplant Unit, Austin Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Simone Strasser
- A W Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Katherine Stuart
- Queensland Liver Transplant Unit, Princess Alexandra Hospital, Brisbane, Australia
| | - Alan Wigg
- South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, Australia
| | - Gary Jeffrey
- West Australian Liver Transplant Unit, Charles Gardiner Hospital, Perth, Australia
| | - Ed Gane
- New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
| | - Peter W Angus
- Liver Transplant Unit, Austin Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
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16
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Liver cirrhosis mortality, alcohol consumption and tobacco consumption over a 62 year period in a high alcohol consumption country: a trend analysis. BMC Res Notes 2015; 8:822. [PMID: 26708239 PMCID: PMC4691532 DOI: 10.1186/s13104-015-1808-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 12/14/2015] [Indexed: 12/27/2022] Open
Abstract
Background The relationship between alcohol consumption and liver cirrhosis mortality has been revealed by data from several different countries. However, the impact of tobacco smoking on liver cirrhosis has not been considered. The aim of this study was to estimate trends in liver cirrhosis mortality and alcohol and tobacco consumption from 1952 to 2013 as well as more recent trends in substance use disorder treatments and hospital treatments of liver diseases in Germany. Methods Data from the National Statistics Office were used. Liver cirrhosis was diagnosed according to the International Classification of Diseases (ICD-6 to ICD-10). Alcohol beverages and tobacco products were estimated according to tax or governmental data. Substance use disorder treatment and hospital treatment data were used. Trends were calculated using Joinpoint regression analyses. Results Liver cirrhosis mortality among men increased annually by 8.4 % from 1952 to 1960 and increased annually by 2.8 % from 1961 to 1976. From 1976 to 1982, liver cirrhosis mortality decreased annually by 4.8 %, from 1982 to 2013 liver cirrhosis mortality decreased annually by 1.2 %. Among females, liver cirrhosis mortality increased annually by 8.9 % from 1952 to 1959 and by 4.3 % from 1959 to 1968, but then decreased 1.0 % annually from 1968 to 1995. After 1995, liver cirrhosis mortality decreased 1.9 % annually through 2013. These reductions in liver cirrhosis mortality were accompanied by decreases in alcohol consumption beginning in 1976. These findings were also accompanied by decreases in the consumption of cigarette equivalents since 1971. Meanwhile, the number of substance use disorder treatments and hospital treatments of liver diseases increased. Conclusions The decrease in liver cirrhosis mortality may have been caused by a decrease in alcohol drinking and tobacco smoking. Smoking may have exerted indirect effects via alcohol consumption as well as direct effects. These trends existed despite largely missing preventive efforts to reduce alcohol consumption and tobacco smoking. Increases in educational attainment in the general population may have contributed to the reductions in alcohol and tobacco consumption. Convincing evidence that the increased provision of substance use disorder treatment significantly contributed to the decrease of liver cirrhosis was not found. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1808-2) contains supplementary material, which is available to authorized users.
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Landmann M, Wagnerberger S, Kanuri G, Ziegenhardt D, Bergheim I. Beer Is Less Harmful for the Liver than Plain Ethanol: Studies in Male Mice Using a Binge-Drinking Model. Alcohol Alcohol 2015; 50:493-500. [DOI: 10.1093/alcalc/agv048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/23/2015] [Indexed: 12/19/2022] Open
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18
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Allamani A, Voller F, Pepe P, Baccini M, Massini G, Cipriani F. Italy between drinking culture and control policies for alcoholic beverages. Subst Use Misuse 2014; 49:1646-64. [PMID: 25122545 DOI: 10.3109/10826084.2014.913386] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This paper focuses on whether the on-going dramatic decrease in alcohol consumption in Italy, especially of wine, during 1961-2008, was associated with which parallel sociodemographic and economic changes and with alcohol control policies. The study, using both time series (TS) and artificial neural network (ANN)-based analyses documents that its selected sociodemographic and economic factors, and particularly urbanization, had a definite connection with wine consumption decrease, spirits decrease, and the increase in beer consumption over time. On the other hand, control policies showed no effect on the decline in alcohol consumption, since no alcohol control policy existed in Italy between 1960 and 1987. A few policies introduced since 1988 (BAC and sale restrictions during mass events) may have contributed to reducing or to maintaining the on-going reduction. Study limitations are noted and future needed research is suggested.
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Jiang H, Livingston M, Manton E. The effects of random breath testing and lowering the minimum legal drinking age on traffic fatalities in Australian states. Inj Prev 2014; 21:77-83. [PMID: 25223238 DOI: 10.1136/injuryprev-2014-041303] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study aims to apply time series analysis techniques to examine the effects of random breath testing (RBT) on three age-specific traffic fatalities in four Australian states while considering the effects of lowering the minimum legal drinking age (MLDA). METHODS Long-term time series of age-specific traffic crash deaths in four Australian states were used to analyse the impact of RBT implementation while considering the population growth, increase in motor vehicle registrations and the effects of lowering the MLDA. RESULTS The results of intervention analysis indicate that RBT has substantially reduced traffic fatalities in all four states since it was introduced, particularly among the 17-year-olds to 20-year-olds and 21-year-olds to 30-year-olds. New South Wales received the biggest total net effect from RBT implementation on traffic deaths. By contrast, RBT produced only a modest reduction in traffic fatalities among 30-year-olds to 39-year-olds. Lowering the MLDA was associated with significant increases in traffic fatalities among 17-year-olds to 39-year-olds in Queensland and Western Australia. CONCLUSIONS Controlling for the declining trend in traffic fatalities, the effects of changes in the MLDA law, the implementation of RBT has generated a huge effect, preventing an estimated 5279 traffic crash deaths in four Australian states. This provides further evidence that the implementation of RBT and increases in the MLDA are effective policies for reducing traffic fatalities.
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Affiliation(s)
- Heng Jiang
- Turning Point, Centre for Alcohol Policy Research, Melbourne, Victoria, Australia Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Michael Livingston
- Turning Point, Centre for Alcohol Policy Research, Melbourne, Victoria, Australia Drug Policy Modelling Program, National Drug and Alcohol Research Centre, The University of New South Wales, New South Wales, Australia
| | - Elizabeth Manton
- Turning Point, Centre for Alcohol Policy Research, Melbourne, Victoria, Australia Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
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