Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Observatorio Multicéntrico de Enfermedades Gastrointestinales, OMEGA, Santiago, Chile.
Observatorio Multicéntrico de Enfermedades Gastrointestinales, OMEGA, Santiago, Chile; Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
J Hepatol. 2024 Mar;80(3):409-418. doi: 10.1016/j.jhep.2023.11.006. Epub 2023 Nov 21.
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.
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.
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).
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.
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.
酒精相关公共卫生政策（PHP）对疾病负担的长期影响尚不清楚。我们旨在评估酒精相关 PHPs 与酒精相关健康后果之间的关联。
我们进行了一项包括 169 个国家的生态多国家研究。我们从 2010 年世界卫生组织全球酒精与健康信息系统中收集了酒精相关 PHPs 数据。2010-2019 年期间的酒精相关健康后果数据来自全球疾病负担数据库。我们将 PHPs 分为五个项目，包括低、中、强 PHP 建立的标准。我们使用多元对应分析（0 最低和 100 最高建立）来估计酒精准备指数（API）。我们使用具有泊松家族分布的调整多层广义线性模型根据 API 估计结局的发病率比值比（IRR）。
169 个国家的 API 中位数为 54 [IQR 34.9-76.8]。API 与酒精使用障碍（AUD）患病率呈负相关（IRR 0.13；95%CI 0.03-0.60；p = 0.010），酒精相关性肝病（ALD）死亡率（IRR 0.14；95%CI 0.03-0.79；p = 0.025），恶性肿瘤死亡率（IRR 0.09；95%CI 0.02-0.40；p = 0.002），酒精相关性肝细胞癌（HCC）（IRR 0.13；95%CI 0.02-0.65；p = 0.014）和心血管疾病（IRR 0.09；95%CI 0.02-0.41；p = 0.002）。在美洲、非洲和欧洲观察到最高的关联。这些关联随着时间的推移而增强，AUD 患病率在基线 API 评估后 2 年内显著降低，而 ALD 死亡率和酒精相关性 HCC 发病率分别在基线 API 评估后 4 年和 8 年下降（p<0.05）。
API 是量化酒精相关 PHP 建立稳健性的有用工具。在 API 较高的国家，观察到 AUD 患病率较低，与 ALD、恶性肿瘤、酒精相关性 HCC 和心血管疾病相关的死亡率较低。我们的结果鼓励在全球范围内制定和加强与酒精相关的政策。
我们首先开发了一个酒精准备指数，这是一种用于评估每个国家是否存在酒精相关公共政策的工具。然后，我们评估了 2010 年该国酒精准备指数与慢性肝病、肝细胞癌、其他肿瘤和心血管疾病负担之间的长期关联。酒精相关公共卫生政策的加强可能会影响心血管疾病、肿瘤和肝病的长期死亡率。这些情况是与酒精使用相关的全球疾病负担的主要原因。随着时间的推移，这种关联不仅持续存在，而且还变得更加强烈。我们的结果扩展了关于公共卫生政策在控制酒精相关健康后果方面重要性的初步证据。
