The effects of a large reduction in alcohol prices on hospitalizations related to alcohol: a population-based natural experiment

Aims Finland experienced a large reduction in alcohol prices in 2004 due to in the lowering of alcohol taxes by about one‐third and the abolition of duty‐free allowances for travellers from the European Union. We examined the effects of these changes on alcohol‐related hospitalizations. Design and participants Time—series intervention analyses of monthly aggregations of hospitalization for acute and chronic causes among men and women aged 15–39, 40–49, 50–69 and more than 69 years. Setting Finland, 1996–2006. Findings After the price reduction the chronic hospitalization rate for men increased among those below age 70 years. It was largest among those aged 50–69 years: 22%, which implies an increase of 18.0 monthly hospitalizations per 100 000 person‐years, and there was an 11% and 16% (11.5 and 4.8 monthly hospitalizations) increase among those aged 40–49 and 15–39, respectively. Among the women the rate increased by 23% (4.0 monthly hospitalizations) in the 50–69‐year‐olds, and decreased in the under‐40s. The increase in all the population groups was due mainly to an increase in mental and behavioural disorders due to alcohol. Acute hospitalizations increased by 17% and 20% (6.2 and 7.0 per month) among men aged 40–49 and 50–69 years, respectively, and by 38% among women aged 50–69 years (2.3 per month). Conclusions The results, obtained in a natural experimental setting when trends and seasonal variation had been taken into account, suggest that the reduction in alcohol prices led to increases in alcohol‐related hospitalization in certain population groups, mainly among 50–69‐year‐olds, in Finland.     

Predictors of injury‐related and non‐injury‐related mortality among veterans with alcohol use disorders

Aims To describe the association between alcohol use disorders (AUDs) and mortality and to examine risk factors for and all‐cause, injury‐related and non‐injury‐related mortality among those diagnosed with an AUD. Setting Department of Veterans Affairs, Veterans Health Administration (VHA). Participants A cohort of individuals who received health care in VHA during the fiscal year (FY) 2001 (n = 3 944 778), followed from the beginning of FY02 through the end of FY06. Measurements Demographics and medical diagnoses were obtained from VHA records. Data on mortality were obtained from the National Death Index. Findings Controlling for age, gender and race and compared to those without AUDs, individuals with AUDs were more likely to die by all causes [hazard ratio (HR) = 2.30], by injury‐related (HR = 3.29) and by non‐injury‐related causes (HR = 2.21). Patients with AUDs died 15 years earlier than individuals without AUDs on average. Among those with AUDs, Caucasian ethnicity and all mental illness diagnoses that were assessed were associated more strongly with injury‐related than non‐injury‐related mortality. Also among those with AUDs, individuals with medical comorbidity and older age were at higher risk for non‐injury related compared to injury‐related mortality. Conclusions In users of a large health‐care system, a diagnosis of an AUD is associated significantly with increased likelihood of dying by injury and non‐injury causes. Patients with a diagnosis of an AUD who die from injury differ significantly from those who die from other medical conditions. Prevention and intervention programs could focus separately upon selected groups with increased risk for injury or non‐injury‐related death.     

Blood pressure reduction during treatment for alcohol dependence: results from the Combining Medications and Behavioral Interventions for Alcoholism (COMBINE) study

Aims Heavy drinking is associated with hypertension. This study evaluated blood pressure changes occurring during treatment for alcohol dependence. Participants Subjects included 1383 people participating in the Combining Medications and Behavioral Interventions for Alcoholism (COMBINE) study, a large multi‐center treatment study for alcohol dependence. Measurements Methods appropriate for repeated‐measures data were used to assess the relationship of percentage of drinking days (PDD) to systolic and diastolic blood pressure over a 16‐week treatment period. Modification of these associations by demographic and other variables was assessed. Findings Blood pressure reduction was evident only in people who were above the median blood pressure at baseline. In this group, systolic blood pressure decreased by an average of 12 mmHg and diastolic blood pressure decreased by an average of 8 mmHg. Blood pressure reduction occurred during the first month of treatment. This effect was similar regardless of age, sex, body mass index, reported history of hypertension and use of anti‐hypertensive medications. An observed association between blood pressure and PDD in Caucasians was not evident in African Americans due largely to their lower pre‐treatment blood pressure. Conclusions Reduction in alcohol consumption has a potent anti‐hypertensive effect in alcoholics with higher blood pressure. For hypertensive, alcohol‐dependent people, treatment for alcoholism should be considered a major component of anti‐hypertensive therapy.