评估荷兰医疗改革的影响：在国家监测数据中评估酒精禁令对性传播感染的影响。

Evaluating the impact of health reforms in the Netherlands: Assessing the impact of an alcohol ban on sexually transmitted infections in national surveillance data.

作者信息

Den Daas C, Van Aar F, Van Benthem B H B

机构信息

Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, the Netherlands; Interdisciplinary Social Science, Utrecht University, PO Box 80140, 3508 TC, Utrecht, the Netherlands.

Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, the Netherlands.

出版信息

Health Policy. 2019 Oct;123(10):992-997. doi: 10.1016/j.healthpol.2019.07.017. Epub 2019 Jul 29.

DOI:10.1016/j.healthpol.2019.07.017

PMID:31399261

Abstract

BACKGROUND

On 1 January 2014, the minimum age to buy alcohol increased (16-18 years), accompanied by a public awareness campaign (NIX18). Decreases in alcohol consumption are associated with less risky sexual behaviour. This study analyzed the association between the health reforms andChlamydia trachomatis infections (chlamydia) among young heterosexual people.

METHODS

Chlamydia positivity rates, age, and gender from all STI-clinic attendees between 16 and 19 years old in the Netherlands of 2010 to 2016 were obtained. Interrupted time-series assessed immediate and gradual trends in chlamydia rates.

RESULTS

Among the control group (18-19 year olds) chlamydia rates increased 0.5% each post-ban month (95% Confidence Interval [CI] 1.002-1.008, p = .001). Among 16-17 year olds there was no monthly increase post-ban (Rate Ratio 1.000, 95% CI 0.993-1.007, p = .948). In terms of confounders, only controlling for partner notification dissolved these time trends.

CONCLUSIONS

We found that chlamydia rates after the alcohol ban differed between 16-17 year olds and 18-19 year olds. This demonstrates that the health reforms might have affected this secondary outcome, but obtaining certainty using national surveillance data is difficult. Specific studies should be designed, as now changes in chlamydia over time could be explained by STI-clinic policy changes, by changes on an individual level including reduced alcohol consumption or most likely by the combination of these factors.

摘要

背景

2014年1月1日，购买酒精饮料的最低年龄提高到了18岁（此前为16岁），同时开展了一场公众宣传活动（“18禁”）。酒精消费量的减少与危险性行为的减少相关。本研究分析了这些健康改革措施与年轻异性恋人群沙眼衣原体感染（衣原体感染）之间的关联。

方法

获取了2010年至2016年荷兰所有16至19岁性传播感染门诊就诊者的衣原体阳性率、年龄和性别信息。采用中断时间序列分析评估衣原体感染率的即时和渐进趋势。

结果

在对照组（18至19岁人群）中，禁令实施后每个月衣原体感染率上升0.5%（95%置信区间[CI]为1.002 - 1.008，p = 0.001）。在16至17岁人群中，禁令实施后感染率没有每月上升的情况（率比为1.000，95% CI为0.993 - 1.007，p = 0.948）。在混杂因素方面，只有对性伴通知情况进行控制才能消除这些时间趋势。

结论

我们发现，酒精禁令实施后，16至17岁人群和18至19岁人群的衣原体感染率存在差异。这表明这些健康改革措施可能对这一间接结果产生了影响，但利用国家监测数据来确定这一点存在困难。应设计专门的研究，因为目前衣原体感染随时间的变化可能是由性传播感染门诊政策变化、个体层面的变化（包括酒精消费量减少）或最有可能是这些因素的综合作用所导致的。