van der Velde Lode, Shabaan Ahmed Nabil, Månsson Anastasia, Wennberg Peter, Allebeck Peter, Karlsson Thomas G, Flodin Pär, Eikemo Terje Andreas, Skrindo Knudsen Ann Kristin, de Soysa Indra, Skogen Jens Christoffer, Gissler Mika, McGrath John J, Sigfusdottir Inga Dora, Sigurvinsdottir Rannveig, Pasovic Maja, Danielsson Anna-Karin, Agardh Emilie E
Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.
Eur J Public Health. 2025 Feb 1;35(1):52-59. doi: 10.1093/eurpub/ckae195.
It is still unclear how changes in alcohol control policies may have contributed to changes in overall levels of alcohol-attributed harm between and within the Nordic countries. We modified and applied the Bridging the Gap (BtG)-scale to measure the restrictiveness of a set of alcohol control policies for each Nordic country and each year between 1990 and 2019. Alcohol-attributed harm was measured as total and sex-specific alcohol-attributed disease burden by age-standardized years of life losts (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) per 100 000 population from the Global Burden of Disease Study (GBD). Longitudinal cross-country comparisons with random effects regression analysis were employed to explore associations, within and across countries, differentiated by sex and the time to first effect. Overall, alcohol-attributed YLLs, YLDs, and DALYs decreased over the study period in all countries, except in Iceland. The burden was lower in those countries with restrictive national policies, apart from Finland, and higher in Denmark which had the least restrictive policies. Changes in restrictiveness were negatively associated with DALYs for causes with a longer time to effect, although this effect was stronger for males and varied between countries. The low alcohol attributed disease burden in Sweden, Norway, and Iceland, compared to Denmark, points towards the success of upholding lower levels of harm with strict alcohol policies. However, sex, location and cause-specific associations indicate that the role of formal alcohol policies is highly context dependent and that other factors might influence harm as well.
目前仍不清楚酒精控制政策的变化是如何导致北欧国家之间以及国家内部酒精所致伤害总体水平发生变化的。我们修改并应用了“缩小差距”（BtG）量表，以衡量1990年至2019年期间每个北欧国家每年一套酒精控制政策的严格程度。酒精所致伤害通过全球疾病负担研究（GBD）中每10万人口按年龄标准化的寿命损失年数（YLLs）、带病生存年数（YLDs）和伤残调整生命年数（DALYs）来衡量，包括总体和按性别划分的酒精所致疾病负担。采用随机效应回归分析进行纵向跨国比较，以探讨国家内部和国家之间按性别以及首次效应时间区分的关联。总体而言，在研究期间，除冰岛外，所有国家的酒精所致YLLs、YLDs和DALYs均有所下降。除芬兰外，国家政策严格的国家负担较低，而丹麦政策限制最少，负担较高。对于起效时间较长的病因，严格程度的变化与DALYs呈负相关，尽管这种影响在男性中更强且因国家而异。与丹麦相比，瑞典、挪威和冰岛的酒精所致疾病负担较低，这表明严格的酒精政策在维持较低伤害水平方面取得了成功。然而，性别、地点和特定病因的关联表明，正式酒精政策的作用高度依赖具体情况，其他因素也可能影响伤害情况。
