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

This short brief describes the main findings and the key lessons learned from the research project "Evaluation of the impact of alcohol control policies on morbidity and mortality in Lithuania and other Baltic states", funded by the United States National Institute on Alcohol Abuse and Alcoholism for the period 2000–2025. The WHO-backed project aims to assess the effects of alcohol control policies implemented in Estonia, Latvia and Lithuania and to investigate the impact they have had on both people's health and the countries' economies, based on concrete actions taken. The key findings of the project demonstrate that alcohol control policies such as taxation and availability measures decrease all-cause mortality and reduce inequalities, and that dismantling alcohol control policies has the opposite effect on population health. They also highlight that consumption of unrecorded alcohol will not necessarily go up if taxation is increased and that specific countermeasures can be taken to prevent an increase in unrecorded consumption.

[...]. Alcohol advertising exposure is a risk factor for earlier alcohol initiation and higher alcohol consumption. Furthermore, engagement in digital alcohol marketing, such as liking or sharing an ad on social media, is associated with increased alcohol consumption and binge or hazardous drinking behavior. • In light of these challenges, in 2018 Lithuania has enacted a total prohibition on alcohol advertising, including social media. • This study monitored the two most popular social media networks, Facebook and Instagram, to determine compliance with current legislation. • In total, 64 Facebook and 51 Instagram profiles were examined. • During the 60-day study period, 1442 and 749 posts on the selected Facebook and Instagram profiles, respectively, were published. [...]. Conclusions • The study demonstrates high compliance with Lithuania’s total alcohol advertising ban on social media and emphasizes the importance of adequately monitoring the growing prominence of influencers on social media. • Influencers were responsible for nearly half (45.5 percent) of all observed alcohol related Instagram posts. • The advertising of non-alcoholic beverages may be a growing problem if it becomes more popular among young people – a reduced entry gate to getting used to tastes?

Given the causal impact of alcohol use on stroke, alcohol control policies should presumably reduce stroke mortality rates. This study aimed to test the impact of three major Lithuanian alcohol control policies implemented in 2008, 2017 and 2018 on sex- and stroke subtype-specific mortality rates, among individuals 15+ years-old. Joinpoint regression analyses were performed for each sex- and stroke subtype-specific group to identify timepoints corresponding with significant changes in mortality rate trends. To estimate the impact of each policy, interrupted time series analyses using a generalized additive mixed model were performed on monthly sex- and stroke subtype-specific age-standardized mortality rates from January 2001-December 2018. Significant average annual percent decreases were found for all sex- and stroke subtype-specific mortality rate trends. The alcohol control policies were most impactful on ischemic stroke mortality rates among women. The 2008 policy was followed by a positive level change of 4,498 ischemic stroke deaths per 100,000 women and a negative monthly slope change of -0.048 ischemic stroke deaths per 100,000 women. Both the 2017 and 2018 policy enactment timepoints coincided with a significant negative level change for ischemic stroke mortality rates among women, at -0.901 deaths and -1.431 deaths per 100,000 population, respectively. Hemorrhagic stroke mortality among men was not affected by any of the policies, and hemorrhagic stroke mortality among women and ischemic stroke mortality among men were only associated with the 2008 policy. Our study findings suggest that the impact of alcohol control policies on stroke mortality may vary by sex and subtype.

Alcohol per capita consumption in Lithuania among the population 15 years of age and older has been among the highest globally in recent decades. Long-term alcohol consumption trends and drinking patterns signal a significant public health problem, as well as social and economic losses. This study aimed to estimate the economic burden associated with alcohol consumption in Lithuania from 2015 to 2020. We used a cost-of-illness methodology with the human capital approach to estimate the economic burden and applied a prevalence-based approach. Using multiyear data, we estimated both, direct and indirect costs. Direct costs included healthcare and childcare, law enforcement, and justice system costs. Indirect costs included costs of productivity loss due to premature mortality. The total economic cost of alcohol consumption in Lithuania between 2015 and 2020 was estimated at an annual average of €542.958 million (in 2020 Euros) or about 1.18% of the Lithuanian total Gross Domestic Product. The highest proportion (65%) of the estimated costs was associated with productivity losses due to premature mortality. Alcohol use places a considerable burden on Lithuanian society in terms of illness, injury, death, and economic costs. Alcohol control policies, in particular excise taxation increases and availability restrictions have been shown to decrease this burden.

For many years alcohol consumption in Lithuania has been widely identified as a major challenge for health in the society, and major changes in alcohol control legislation has started in 2008–2009 when excise taxation has been increased, alcohol advertising has been limited during daytime, night off-premise sales of alcohol has been banned, and drink-driving legislation significantly toughened. The next period of new alcohol control measures took place in 2014–2018 when excise taxation has been increased multiple times (including doubling of excise for beer and wine in 2017), alcohol sales in petrol stations has been banned since 2016. Since 2018 a legal alcohol purchase age has been increased from 18 to 20 years of age, and a near full alcohol advertising ban introduced in all social and media outlets. The policies implemented during those two periods may be associated with a significant impact to health indicators of Lithuanian population. Life expectancy at birth from 2007 to 2019 has increased by 5.7 years, followed by significant declines in many alcohol related indicators. For instance, in 2019 a standardized alcohol attributable mortality indicator has been 3 times lower comparing to a year 2007 (a decline from 57.8 deaths per 100 000 in 2007 to 16.8 deaths per 100 000 in 2019). The more detailed analysis of the effects of alcohol control policies have identified that the all-cause mortality has declined by about 3% more during periods when alcohol control policies were introduced comparing with the periods without new policies. According to WHO estimates in 2016 Lithuania was a country consuming the most alcohol in the European Region. However, the most significant changes per capita alcohol consumption in Lithuania was also observed in recent years when in 2015 a recorded alcohol consumption among 15 years old and older populations was 14 liters and it has declined to 11.1 liters in 2019. It is important to note, that despite the positive declining trends of recorded alcohol consumption and alcohol related mortality indicators, the budgetary income from excise taxation has increased, especially during the last few years (the excise income has increased by 44% from 2016 to 2019). In summary, Lithuania sets an example in the field of public health showing how strong alcohol control policies (including WHO “best buys”) may significantly contribute in improving multiple public health indicators in a relatively short period of time.

We tested the polarization hypothesis, which postulates that during times of crises, such as the COVID-19 pandemic, alcohol consumption increases among the heaviest drinkers but decreases among most other drinkers, resulting in an overall decrease in consumption among the population. We posited the increase in heavy drinking would lead to increases in 100% alcohol-attributable (AA) mortality. Furthermore, based on the high level of alcohol consumption in the Baltic countries compared to other European countries, we predicted that the increases in AA mortality would be more pronounced in these countries.

Lithuania, a Baltic country in the European Union, can be characterized by high alcohol consumption and attributable burden. The aim of this contribution is to estimate the mortality burden due to alcohol use for the past two decades based on different relative risk functions, identify trends, and analyse the associations of alcohol-attributable burden with alcohol control policies and life expectancy.

The aim of the current study was to test the impact of three alcohol control policy enactments (in 2008, 2017 and 2018) on assaults and sexual assaults in Lithuania. The hypothesis tested was that alcohol control policy implementation is associated with a reduction in the occurrence of both assaults and sexual assaults.

Aims: To conduct a return on investment analysis of Lithuania’s 2017 increase in alcohol excise taxation of 112% for beer, 111% for wine, and 23% for ethyl alcohol (spirits), resulting in a marked decrease in alcohol affordability. Methods: Economic analyses based on costs of the increased taxation and economic benefits derived from a societal perspective. Costs were measured according to World Health Organization standards, based on Lithuanian public data. Benefits were derived from the difference of direct (healthcare, childcare, legal) and indirect costs between 12 months pre- and post-enactment of the policy. All costs and benefits were expressed in 2023 Euros (€). Results: Overall, there were net benefits from reductions in productivity losses and increases in tax revenue. Tax revenue increased by 20%, or more than €100 million, in the first-year post enactment, and productivity losses decreased over the same time period by about €35.3 million (95% confidence interval [CI]: −51.9 to −17.1; proportionally −7%; 95% CI: −11.0% to −4.0%), the latter based on marked reductions in premature mortality in all alcohol-attributable causes of death. In addition, healthcare costs decreased by about €3.8 million (95% CI: −8.4 to +0.1; proportionally −5%; 95% CI: −11.0% to +0.1%). On the other hand, childcare and legal costs increased compared with the year before, by €5.3 million (no 95% CI possible; proportionally: +7%) and €4.6 million (95% CI: +0.2 to +8.0; proportionally +5%; 95% CI: +0.3 to +8.7%), respectively. The final return on investment was 420 to 1, i.e. for each Euro invested, the return was €420. In the sensitivity analyses, the return on investment varied between 292 to 1 and 530 to 1, meaning that all assumptions resulted in a very positive return. Conclusions: The increase in excise taxation for alcohol on March 1, 2017 in Lithuania created a large return on investment and reduced alcohol-attributable mortality and hospitalizations.

Aims: From 1 January 2018, the number of retail hours for the sale of alcohol was reduced from 14 to 5 hours on Sundays and from 14 to 10 hours on the other days of the week in Lithuania. The significant reduction of hours for the sale of alcohol on Sundays may have affected the distribution of alcohol-attributable deaths during the week. This study aimed to examine the change in the weekly pattern of alcohol-attributable male mortality before and after imposing limits on the hours when alcohol can be sold. Methods: Age-standardised male death rates by days of the week were calculated for four groups according to cause of death: alcohol poisoning (X45), all external causes of death (V01–Y98), diseases of the circulatory system (I00–I99) and all other causes of death. We compared age-standardised death rates for two periods: before (2015–2017) and after (2018–2019) the intervention. Mortality and population data were obtained from the Lithuanian Institute of Hygiene and Human Mortality Database. Results: We found that during 2018–2019, earlier observed peak in age-standardised death rates for external causes of death on Sunday diminished, and this day no longer differed from the weekly average. The same tendency was also observed for the Monday excess mortality due to circulatory diseases. Conclusions: The reduction of the hours when alcohol can be sold from the beginning of 2018 was associated with a change in a weekly pattern of alcohol-attributable male mortality. However, more studies are needed to examine the causes of the change in mortality pattern.