O-11 THE PUBLIC HEALTH POLICIES REDUCE THE LONG-TERM BURDEN OF ALCOHOL-ASSOCIATED LIVER DISEASE WORLDWIDE: DEVELOPMENT OF A PREPAREDNESS INDEX

Introduction and Objectives

The long-term impact of alcohol-related public health policies (PHP) on the burden of liver disease is unclear. This study aimed to assess the association between alcohol-related PHP and alcohol-related health consequences; 2. To develop an instrument to quantify the establishment of alcohol-related PHP in each country.

Materials and Methods

We performed an ecological multi-national study including 169 countries. We recorded socio-demographic data and the presence of alcohol-related PHP in each country from the WHO Global Information System of Alcohol and Health (GISAH) in 2010. Data on alcohol-related health consequences was collected from the Global Burden of Disease database (between 2010-2019). We classified the WHO categories into five domains to design an instrument with criteria for a low, moderate, and strong establishment of PHP. We estimated an incidence rate ratio (IRR) using multilevel generalized linear models with a Poisson family distribution. The models were adjusted by population size, age structure, and gross domestic product. We also estimated a preparedness index using multiple correspondence analysis.

Results

The table summarizes the final instrument. We included 169 countries; the median preparedness index was 54 [34.9-76.8]. The preparedness index was associated with lower alcohol-associated liver disease (ALD) mortality (IRR:0.25, 95%CI: 0.06-1.09, p=0.064), cancer mortality (IRR:0.22, 95%CI: 0.05-0.97, p=0.046), hepatocellular carcinoma (HCC) mortality (IRR:0.20, 95%CI: 0.04-0.95, p=0.043), and cardiovascular mortality (IRR:0.15, 95%CI: 0.04-0.61, p=0.008). There was also a trend to lower alcohol use disorder prevalence (IRR:0.25, 95%CI: 0.06-1.09, p=0.064). The highest linear associations were observed in the Americas and Africa, while Europe exhibits a nonlinear association.

Conclusions

The preparedness index on alcohol policies is a valuable instrument to assess the establishment and strength of PHP. Those countries with a higher number of PHP had lower mortality due to ALD, cancer, HCC, and cardiovascular diseases. Our results strongly encourage the development and implementation of PHP on alcohol consumption worldwide.

Table.- Five-item instrument to assess the strength of alcohol-related public health policies.

Item	WHO Categories	Low-level (0)	Moderate-level (1)	Strong-level (2)
National policy to fight harmful consequences of alcohol	- National Plan	Without WNP	A WNP without a National action plan	A WNP and National action plan
	Written national policy (WNP)
	National action plan
Control over production, pricing, and taxes	- Taxes control, pricing policies	Those without production control or taxes	Some regulations. Taxes in some alcoholic beverages	Strong regulations. Taxes in all alcoholic beverages
	- National license, production, and selling control
Marketing of alcoholic beverages and restrictions to alcohol access	- Control over advertising and promotion	Countries without policies to control ads, access or a national legal minimum age	<50% of policies to control ads and access. There is a drinking age rule.	> 50% of policies to control ads and access. There is a drinking age rule
	- Restrictions to alcohol access
	- National drinking age rule
Drink-driving policies and countermeasures	- Driving-related policies	No restrictions when driving a vehicle or effective penalties for drink driving	Restrictions on blood alcohol concentration when driving a vehicle and effective penalties for drink driving	Zero tolerance to alcohol consumption when driving and effective penalties for drink driving
Monitoring and surveillance	- Monitoring systems	No monitoring systems and support	Monitoring systems or support	Monitoring systems and support