THE IMPACT OF THE ALCOHOL ACT ON ALCOHOL-RELATED HEALTH HARMS IN SCOTLAND
To investigate whether introduction of an Alcohol Act, a change in regulations concerning the sale and promotion of off-trade alcohol, had any effect on rates of alcohol-related deaths and hospital admissions in Scotland.
The data used in this study comprised rates of 1) death and 2) patients admitted to hospital with a wholly attributable alcohol-related diagnosis for consecutive 4-weekly periods between January 2001 and December 2014 (December 2013 for hospitalisations). This population-level data was both for Scotland – the intervention group, and England/Wales (deaths), England (hospitalisations) – the control group.
Random-effects negative binomial regression models were fitted to both the intervention and control data sets with a binary time dependent Alcohol Act covariate taking the value one after the change was introduced in Scotland (1st October 2011 onwards) and a value of zero before. The covariates of age, sex, Carstairs deprivation, month (accounting for seasonal changes) and time (accounting for underlying temporal trends using spline functions) were used for adjustment. In pre-specified sensitivity analyses, we repeated the control group modelling using only the North-East and North-West England regions (combined) as it has been suggested these regions are more alike to Scotland than England/Wales as a whole. Further, we shortened the pre-intervention study period and used false legislation dates (between 12 months and 12 months post 1st October 2011).
The table shows the estimated effect of the Alcohol Act (expressed as incidence rate ratios, IRRs) in Scotland, and the corresponding IRRs for the pseudo-Alcohol Act in England/Wales. There is no evidence to suggest that the Alcohol Act was associated with changes in the overall rate of alcohol-related deaths and hospital admissions in Scotland. The results of the sensitivity analyses were broadly comparable to the main analysis.
Our results suggest that the implementation of the Alcohol Act in Scotland has not had a substantial short-term impact on alcohol-related health harms. Even though a restriction on promotions is important in creating an environment in which alcohol is sold responsibly, our results suggest it is unlikely on its own to substantially reduce the harm caused by alcohol at the population level.
Table: IRRs for association between Alcohol Act legislation and alcohol-related harm
Notes: 1Models with hospital admissions as the outcome included data for England only. 2Sensitivity analysis.