Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto ON Dalla Lana School of Public Health, University of Toronto, Toronto ON.
Adicciones. 2024 Jun 1;36(2):227-236. doi: 10.20882/adicciones.1828.
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.
鉴于饮酒对中风的因果影响，控制酒精的政策应该可以降低中风死亡率。本研究旨在检验 2008 年、2017 年和 2018 年实施的三大立陶宛酒精控制政策对 15 岁以上人群中按性别和中风亚型划分的死亡率的影响。对每个性别和中风亚型特定组进行 Joinpoint 回归分析，以确定与死亡率趋势显著变化相对应的时间点。为了估计每项政策的影响，对 2001 年 1 月至 2018 年 12 月每月按性别和中风亚型划分的年龄标准化死亡率进行了中断时间序列分析，采用广义加性混合模型。所有性别和中风亚型特定的死亡率趋势都发现了显著的平均年百分率下降。这些酒精控制政策对女性缺血性中风死亡率的影响最大。2008 年的政策之后，女性缺血性中风的死亡人数每 10 万人增加了 4498 人，每月斜率下降了 -0.048 人。2017 年和 2018 年的政策实施时间点都与女性缺血性中风死亡率的显著负水平变化相对应，分别为 -0.901 人死亡和 -1.431 人死亡。任何政策都没有影响男性的出血性中风死亡率，而女性的出血性中风死亡率和男性的缺血性中风死亡率仅与 2008 年的政策有关。我们的研究结果表明，酒精控制政策对中风死亡率的影响可能因性别和亚型而异。
