Alcohol remains a significant contributor to mortality and morbidity in Finland and the Baltic countries, particularly among men. This study aimed to assess the restrictiveness of alcohol control policies in this region from 1995 to 2019 using a modified version of the Bridging the Gap (BtG-M) policy scale and examine its association with alcohol-related disease burden.

Methods

Data Sources for Alcohol Policies

The study utilised national laws to score policy restrictiveness and age-standardised rates of disability-adjusted life years (DALY), years of life lost (YLL), years lived with disability (YLD), and deaths per 100,000 from the 2019 Global Burden of Disease Study (GBD). The data were obtained from governmental online law libraries, existing literature, and national authorities.

Alcohol Policy Restrictiveness (Modified BtG Scale)

The BtG scale consists of seven evidence-guided alcohol policy subgroups: control of production, control of distribution, personal control (legal age limits), control of marketing, drunk driving (blood alcohol concentration limits), public policy, and alcohol taxation. The study adapted the original BtG scale to a longitudinal project spanning 1995–2019.

Alcohol-Attributable Burden of Disease

The study analysed age-standardised rates of DALYs, YLLs, YLDs, and deaths per 100,000 with 95% uncertainty intervals between 1995 and 2019. The population attributable fraction was applied to calculate the burden of disease due to alcohol use as a risk factor.

Data Analysis

Spearman correlation tests and panel data regression models were applied to assess the association between policy score and burden of disease. Fixed- and random-effects models were used to account for unobserved and observed variables influencing the data.

Results

Development of Alcohol Control Policies

Finland maintained a high BtG-M score, while the Baltic countries experienced recent increases from initially lower scores. Specific alcohol control measures included tax increases, restrictions on advertising, sale hours, and places. The study found a clear inverse association between policy restrictiveness and alcohol-related disease burden.

Alcohol-Attributable Disease Burden

Finland showed a relatively stable low disease burden, while the Baltic countries experienced a peak in DALYs followed by a decrease corresponding to stricter policies. Lithuania showed the highest DALY rates, peaking at almost 4500 DALYs per 100,000 in 2007, followed by a significant decrease. Estonia and Latvia also showed a decline in DALY rates with increasing policy restrictiveness.

Gender Differences

Men experienced higher DALY rates than women, with premature mortality (YLLs) constituting the largest proportion of the disease burden. Females showed a lower but notable increase in disease burden until 2007, especially in Estonia and Lithuania.

Main Contributors to Disease Burden

AUDs, cardiovascular diseases, liver cirrhosis, and self-harm were primary contributors to DALYs among males. In females, the majority of DALYs were attributed to AUDs, liver diseases, and neoplasms. The study found a decrease in AUDs but an increase in cardiovascular diseases and liver cirrhosis related to alcohol use over the study period.

Statistical Analysis

Spearman correlation analysis showed a strong statistically significant negative correlation between BtG-M scores and DALY rates, YLL rates, and death rates, with a moderate correlation between BtG-M scores and YLD rates. Panel data regression models confirmed the significant effect of policy restrictiveness on reducing the burden of disease.

The study highlighted the strong association between alcohol control policies and alcohol-related harm in Finland and the Baltic countries. By using the BtG-M scale, the study provided valuable insights into the impact of national alcohol policies over a prolonged period and their relationship to alcohol-related disease burden.

Source: Wiley Online Library