Journal
Association between public health policies on alcohol and worldwide cancer, liver disease and cardiovascular disease outcomes
Fecha
2023Registro en:
10.1016/j.jhep.2023.11.006
16000641 01688278
SCOPUS_ID:85180594670
Autor
Diaz Piga, Luis Antonio
Fuentes, López Eduardo
Idalsoaga Ferrer, Francisco Javier
Ayares Campos, Gustavo Ignacio
Corsi Sotelo, Oscar Felipe
Arnold Alvarez, Jorge Ignacio
Cannistra Cadiz, Macarena Rossella
Vio Quiroz, Danae Fernanda
Marquez Lomas, Andrea
Ramirez Cadiz, Carolina Andrea
Medel Salas, María Paz
Hernández Tejero, María
Ferreccio Readi, Fresia Catterina
Lazo Bravo, Mariana Carolina
Roblero Cum, Juan Pablo
Cotter, Thomas G.
Kulkarni ,Anand V.
Kim, Won
Brahmania, Mayur
Louvet, Alexandre
Tapper, Elliot B.
Dunn, Winston
Simonetto, Douglas
Shah, Vijay H.
Kamath, Patrick S.
Lazarus, Jeffrey V.
Singal, Ashwabi K.
Bataller, Ramón
Arrese Jimenez, Marco Antonio
Arab Verdugo, Juan Pablo
Institución
Resumen
© 2023 The Author(s)Background & Aims: The long-term impact of alcohol-related public health policies (PHPs) on disease burden is unclear. We aimed to assess the association between alcohol-related PHPs and alcohol-related health consequences. Methods: We conducted an ecological multi-national study including 169 countries. We collected data on alcohol-related PHPs from the WHO Global Information System of Alcohol and Health 2010. Data on alcohol-related health consequences between 2010–2019 were obtained from the Global Burden of Disease database. We classified PHPs into five items, including criteria for low, moderate, and strong PHP establishment. We estimated an alcohol preparedness index (API) using multiple correspondence analysis (0 lowest and 100 highest establishment). We estimated an incidence rate ratio (IRR) for outcomes according to API using adjusted multilevel generalized linear models with a Poisson family distribution. Results: The median API in the 169 countries was 54 [IQR 34.9–76.8]. The API was inversely associated with alcohol use disorder (AUD) prevalence (IRR 0.13; 95% CI 0.03–0.60; p = 0.010), alcohol-associated liver disease (ALD) mortality (IRR 0.14; 95% CI 0.03–0.79; p = 0.025), mortality due to neoplasms (IRR 0.09; 95% CI 0.02–0.40; p = 0.002), alcohol-attributable hepatocellular carcinoma (HCC) (IRR 0.13; 95% CI 0.02–0.65; p = 0.014), and cardiovascular diseases (IRR 0.09; 95% CI 0.02–0.41; p = 0.002). The highest associations were observed in the Americas, Africa, and Europe. These associations became stronger over time, and AUD prevalence was significantly lower after 2 years, while ALD mortality and alcohol-attributable HCC incidence decreased after 4 and 8 years from baseline API assessment, respectively (p <0.05). Conclusions: The API is a valuable instrument to quantify the robustness of alcohol-related PHP establishment. Lower AUD prevalence and lower mortality related to ALD, neoplasms, alcohol-attributable HCC, and cardiovascular diseases were observed in countries with a higher API. Our results encourage the development and strengthening of alcohol-related policies worldwide. Impact and implications: We first developed an alcohol preparedness index, an instrument to assess the existence of alcohol-related public policies for each country. We then evaluated the long-term association of the country's alcohol preparedness index in 2010 with the burden of chronic liver disease, hepatocellular carcinoma, other neoplasms, and cardiovascular disease. The strengthening of alcohol-related public health policies could impact long-term mortality rates from cardiovascular disease, neoplasms, and liver disease. These conditions are the main contributors to the global burden of disease related to alcohol use. Over time, this association has not only persisted but also grown stronger. Our results expand the preliminary evidence regarding the importance of public health policies in controlling alcohol-related health consequences.