Strong Alcohol Policies Lower Deaths from Liver Damage.

Stronger state restrictions on alcohol are associated with lower death rates from alcoholic cirrhosis, a new study co-authored by School of Public Health and Boston Medical Center researchers shows.

The new study, published in the journal Preventing Chronic Disease, a publication of the Centers for Disease Control and Prevention, examined the relationship between alcohol policies and alcoholic cirrhosis mortality rates in US states from 2002 to 2011. Each state’s alcohol policy “ environment” was characterized by the Alcohol Policy Scale (APS), a validated assessment of state-level alcohol policies, to gauge the strength of regulations on sales, consumption, and availability. The scale includes 29 indicators that can reduce excessive drinking, including alcohol taxes and alcohol outlet density.

Age-adjusted alcoholic cirrhosis mortality rates were obtained from the CDC. Changes in mortality rates were assessed by gender, race/ethnicity, and geographic region.

The study found that cirrhosis mortality rates varied significantly across states, but were highest among males, residents of states in the Western region, and in states with a high proportion of American Indians/Alaskan Natives (AI/AN).

More restrictive state alcohol policies were associated with lower mortality rates among females, but not among males. However, among non-AI/AN residents, stronger policies were linked with lower cirrhosis mortality rates for both genders combined. The association between state policies and lower mortality rates was strongest in the Northeast and Western regions of the US.

Using the APS , the researchers found that a 10-point increase in a state’s policy score (i.e. stronger regulations) was associated with a 9 percent decrease in the alcoholic cirrhosis death rate among women. Examining mortality rates among non-AI/AN residents found that a 10 point increase in the APS score was associated with an 11-percent decrease in mortality among both sexes, although that decrease was driven primarily by females.

The stronger protective relationship between policies and cirrhosis mortality among non-AI/AN populations reflects a number of challenges related to the prevention of excessive drinking among AI/AN, the authors said. For example, many AI/AN live in autonomous or physically remote regions, in which state alcohol policies may have less influence. Differences in drinking patterns, access to healthcare, or other factors also might have contributed to these findings.

Overall, alcoholic cirrhosis mortality rates in states significantly increased during the study period, from an average of 4.6 deaths per 100,000 population in 2002 to 5.3 deaths per 100,000 population in 2011.

The research team said the findings are in line with a recent study that found stronger state alcohol policies are associated with a lower prevalence of binge drinking and other alcohol-related problems.

“Our results are consistent with a potentially protective role for alcohol policies in reducing cirrhosis mortality,” the authors said. “Tax and price policies appear to be particularly effective for reducing adult binge drinking as well as alcoholic cirrhosis mortality rates, and are likely critical components of an effective alcohol policy environment.”

Excessive alcohol consumption is the third leading preventable cause of death in the US. Alcoholic cirrhosis accounts for nearly half of all cirrhosis deaths.

The research team said the study findings “support that strengthening alcohol policy environments may be beneficial for the overall population in the short-term, despite the long lag [time] between alcohol consumption and death from cirrhosis observed at the individual level.”

The authors recommended that future studies should assess the differential effects of alcohol policies on other health concerns linked to excessive drinking for specific subgroups according to gender, race/ethnicity, and geographic location.

BU authors on the study include: Ziming Xuan, assistant professor of community health sciences at SPH; Timothy Heeren, professor of biostatistics at SPH; Jason Blanchette, research coordinator at Boston Medical Center; and Timothy Naimi, alcohol epidemiologist at Boston Medical Center and associate professor at SPH and the School of Medicine. The corresponding author is Scott Hadland of the division of adolescent/young adult medicine at Boston Children’s Hospital. Monica Swahn of the Institute of Public Health, Georgia State University, also contributed.

—Lisa Chedekel