Alcohol control policies reduce all-cause mortality in Baltic Countries and Poland between 2001 and 2020

Funding Information: Research reported in this publication was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIAAA) (Award Number 1R01AA028224). Publisher Copyright: © 2023, The Author(s).Alcohol consumption in the Baltic countries and Poland is among the highest globally, causing high all-cause mortality rates. Contrary to Poland, the Baltic countries have adopted many alcohol control policies, including the World Health Organization (WHO) "best buys". The aim of this study was to evaluate the impact of these policies, which were implemented between 2001 and 2020, on all-cause mortality. Monthly mortality data for men and women aged 20+ years of age in Estonia, Latvia, Lithuania, and Poland were analysed for 2001 to 2020. A total of 19 alcohol control policies, fulfilling an a-priori defined definition, were implemented between 2001 and 2020 in the countries of interest, and 18 of them could be tested. Interrupted time-series analyses were conducted by employing a generalized additive mixed model (GAMM) for men and women separately. The age-standardized all-cause mortality rate was lowest in Poland and highest in Latvia and had decreased in all countries over the time period. Taxation increases and availability restrictions had short-term effects in all countries, on average reducing the age-standardized all-cause mortality rate among men significantly (a reduction of 2.31% (95% CI 0.71%, 3.93%; p = 0.0045)). All-cause mortality rates among women were not significantly reduced (a reduction of 1.09% (95% CI - 0.02%, 2.20%; p = 0.0554)). In conclusion, the alcohol control policies implemented between 2001 and 2020 reduced all-cause mortality among men 20+ years of age in Baltic countries and Poland, and thus, the practice should be continued.publishersversionPeer reviewe

Impact of the WHO “best buys” for alcohol policy on consumption and health in the Baltic countries and Poland 2000–2020

Funding Information: Funding: Research reported in this publication was in part supported by the (U.S.) National Institute on Alcohol Abuse and Alcoholism (NIAAA) of the National Institutes of Health (NIH), grant number 1R01AA028224 . This research was conducted as part of the project ‘Evaluation of the impact of alcohol control policies on morbidity and mortality in Lithuania and other Baltic states’ and we would like to thank the whole team for their input to wider discussions in generating the research reported in this paper. Content is the responsibility of the authors and does not reflect official positions of the NIAAA or the NIH. Publisher Copyright: © 2023Alcohol use is a major risk factor for burden of disease. This narrative review aims to document the effects of major alcohol control policies, in particular taxation increases and availability restrictions in the three Baltic countries (Estonia, Latvia, and Lithuania) between 2000 and 2020. These measures have been successful in curbing alcohol sales, in general without increasing consumption of alcoholic beverages from unrecorded sources; although for more recent changes this may have been partly due to the COVID-19 pandemic. Moreover, findings from time-series analyses suggest improved health, measured as reductions in all-cause and alcohol-attributable mortality, as well as narrowing absolute mortality inequalities between lower and higher educated groups. For most outcomes, there were sex differences observed, with alcohol control policies more strongly affecting males. In contrast to this successful path, alcohol control policies were mostly dismantled in the neighbouring country of Poland, resulting in a rising death toll due to liver cirrhosis and other alcohol-attributable deaths. The natural experiment in this region of high-income European countries with high consumption levels highlights the importance of effective alcohol control policies for improving population health.Peer reviewe

Socio-economic quality of life differences among the breast cancer patients

Aim of the study: To evaluate the socio-economic differences among the breast cancer patients. Methods: The MSc work was performed in analyzing the quality of life data obtained from EORTC QLQ-C30 and EQ-5D questionnaires, in such a way entering to the Breast cancer economic evaluation study performed in The Department of Prophylactic Medicine. After calculating the EQ-5D utilities and other EORTC quality of life indexes the analysis of investigating how the quality of life is influenced by different socio-economic conditions was performed. The main comparative criteria were: the stage of breast cancer, the year of diagnosis, marital status, age, education, monthly income and the rural/urban surrounding. The total sample size of the study consisted of 284 respondents. The mathematical/statistical analysis was performed using Microsoft Excel 2003 and SPSS 12.0. The main statistical criteria used in the data analysis were: Student (t), Chi Square, Mann-Whitney U, One way ANOVA, post hock LZD tests, and Spearman’s correlation coefficient. The statistical significance level was set at p<0.05. Results: The global quality of life measures such as the EQ-5D utilities, EQ VAS, and the EORTC global health status scale were relatively similar; however, they were significantly smaller when comparing to the results published in the scientific literature. When comparing the indexes of the entire sample, such criteria as EQ-5D “mobility” and “self care” dimensions, and EORTC cognitive and physical functioning were valued relatively better than the others. Alternatively, EQ-5D “anxiety/depression”, EORTC emotional functioning, insomnia, fatigue, and especially – financial difficulties scale, were valued as the criteria representing the worst quality of life points. Living with partner, having a higher or high education and higher income (more than 1000 lt/month), being younger than 70 years old, and having the lower stage of breast cancer were the significant predictors of overall better quality of life (p<0.05). There were relatively small or nearly none differences when comparing the year of breast cancer diagnosis and the rural/urban surrounding. Conclusions: The main overall socio-economic predictors of better quality of life were identified as living with a partner, high education, higher income, younger age and the lower stage of the breast cancer. However, the global quality of life utilities and indexes were significantly lower that the ones in the scientific literature

Social and economic harm of alcohol in Lithuania

The aim of this dissertation was to evaluate the social and economic harm of alcohol in Lithuania. The main objectives were to estimate alcohol-attributable mortality, morbidity, disabilities, to evaluate alcohol related violations of law, and to estimate alcohol-attributable economic costs in Lithuania in 2010. The study includes the data from Institute of Hygiene, SVEIDRA, Disability and Capacity Assessment Service, Department of Statistics, Information Technology and Communications Department, State Mental Health Center, State Patient Fund, Lithuanian Traffic Police Office, Prison Department and Ministry of Social Security and Labour. In total this study included 55 conditions and groups of conditions that are fully or partially attributable to alcohol. 22 of those conditions are 100 per cent attributable to alcohol. The rest were partially attributable to alcohol, which were estimated by applying the Lithuanian specific Alcohol-attributable fractions. The results of this dissertation have identified that alcohol-attributable social and economic harm to society is widely spread across many social welfare sectors, as well as direct health care costs is only one of many alcohol-attributable harm components

Smoking-attributable direct healthcare expenditure in Lithuania: A Prevalence-based annual cost approach

Introduction: The estimates of the economic burden of smoking provide the basis for a comprehensive assessment of the overall economic impact and evidence for potential public health policy intervention by the government. The aim of this paper is to estimate the smoking-attributable direct healthcare expenditure covered by the Compulsory Health Insurance Fund (CHIF) in Lithuania in 2013. Methods: A prevalence-based and disease-specific annual cost approach was applied to 25 smoking-related diseases or disease categories. Our analysis included only direct government healthcare expenditure (reimbursed by CHIF), including: smoking-attributable outpatient and inpatient care services, medical rehabilitation, reimbursable and publicly procured pharmaceuticals and medical aids, the emergency medical aid (ambulance) service, nursing, and expensive tests and procedures. The smoking-attributable expenditure on the above-mentioned healthcare services was calculated by multiplying the total annual expenditure by the corresponding smoking attributable fractions (SAFs). Results: The total smoking-attributable government expenditure amounted to €37.4 million in 2013. This represented 3% of the total CHIF budget in 2013. Smoking-attributable expenditure on inpatient care and medical rehabilitation services was two times higher for male smokers, than for female smokers. Conclusions: Smoking imposes a significant preventable financial cost within the budget of the Lithuanian healthcare system. A quantitative estimation of smoking related healthcare costs could provide an incentive for the development of smoking cessation services, with additional attention towards male smokers, as well as an important focus on smoking prevention among children and youths

The Cost-Effectiveness analysis of cervical cancer screening using a systematic invitation system in Lithuania

In Lithuania, cytological screening of cervical cancer (CC) is largely opportunistic. Absence of standardized systematic invitation practice might be the reason for low participation rates. The study aimed to assess the cost-effectiveness of systematic invitation approach in CC screening programme from the perspective of a healthcare provider. A decision tree was used to compare an opportunistic invitation by a family doctor, a personal postal invitation letter with appointment time and place, and a personal postal invitation letter with appointment time and place with one reminder letter. Cost-effectiveness was defined as an incremental cost-effectiveness ratio (ICER) per one additionally screened woman and per one additional abnormal Pap smear test detected. The ICER of one personal postal invitation letter was €9.67 per one additionally screened woman and €55.21 per one additional abnormal Pap smear test detected in comparison with the current screening practice. The ICER of a personal invitation letter with an additional reminder letter compared to one invitation letter was €13.47 and €86.88 respectively. Conclusions: A personal invitation letter approach is more effective in increasing the participation rate in CC screening and the number of detected abnormal Pap smears; however, it incurs additional expenses compared with current invitation practice

Assessing formation of evidence based tobacco and alcohol control policy in Lithuania: the retrospective analysis of voting of the members of parliament

Goal. To develop the instrument for monitoring and assessment of the Members of Parliament (MP) voting patterns on tobacco and alcohol control policy and present main results of the changes in voting indicator (rating) during 2012–2015. Methodology. Analysis was conducted using statistical data of MP voting on the issues of the tobacco and alcohol control policy publicly available on the internet page of the Parliament of the Republic of Lithuania. Final analysis included 57 law amendments voted on between 16th of November, 2012 and 30th of June, 2015, after assessment of their potentially positive or negative impact on public health. The instrument is used to assess individual MPs and political parliamentary factions based on their votes on the issues of tobacco and alcohol control policy. The final rating was based on calculating weight coefficient depending of the MP vote having the potentially positive or negative impact on public health. A sum of each MPs positive and negative votes was then converted into 10 point scoring system, with the worst assessment of 0 and best – 10. Overall assessment of each Parliamentary faction was calculated as an average of the scores of individual faction members. Results. The instrument for assessment of the Republic of Lithuania MPs voting patterns has been developed and implemented for the six Parliamentary sessions during 2012– 2016. On average 75 MPs voted per voting round (min. 38; max. 114) through 57 voting rounds included in the final analysis. Out of 146 current and former MPs assessed with this instrument 58 percent received less than 5 points (negative assessment), 27 percent were assessed 5-7 points, 13 percent received 8 points and 2 percent – 9-10 points. The assessment of the Parliamentary factions revealed differences between individual voting pattern and that of a political group to which MP belongs. Highest assessments were received by the Lithuanian Polish Election Action and Lithuanian Homeland Union and Lithuanian Christian Democratic political groups (accordingly 6.3 and 5.9 points). Labour party and Order and Justice political groups received barely positive assessment (accordingly 5.1 and 5.3 point). Negative assessments were received by the Liberal Movement political group (2.3 points), the Lithuanian Socialdemocratic Party political group (4.4 point) and the Mixed parliament political group (4.6 point). Conclusions. Assessment of the MP voting patterns has revealed differences between individual MPs and political factions voting rating, also large differences within factions. Over half of the MPS received negative rating assessments. Non-attendance of the Parliamentary meetings by MPs had a significant impact on their negative rating. Instrument is suitable for monitoring individual MPs and political factions inclination to favour public heath interest.Tikslas. Sukurti LR Seimo narių balsavimo tabako ir alkoholio kontrolės politikos srityje vertinimo instrumentą bei pristatyti pagrindinius balsavimo rodiklio (reitingo) rezultatus, apibendrinančius 2012–2015 m. LR Seimo narių balsavimus. Tyrimo metodika. Remiantis LR Seimo interneto svetainėje pateikiama balsavimų tabako ir alkoholio kontrolės politikos klausimais statistika, analizuoti 57 visuomenės sveikatos požiūriu teigiami ir neigiami balsavimai, vykę nuo 2012 m. lapkričio 16 d. iki 2015 m. birželio 30 d. Tyrime vystomas metodinis instrumentas, kuris padeda įvertinti tabako ir alkoholio kontrolės politikos klausimais balsuojančius LR Seimo narius ir frakcijas. LR Seimo narių įvertinimai skaičiuoti sumuojant kiekvieną balsą, prilygintą atitinkamam svorio koeficientui, atsižvelgiant į tai, ar balsuota teigiamai, neigiamai, susilaikyta arba iš viso nedalyvauta posėdžio balsavime. Susumuota kiekvieno LR Seimo nario teigiamų ir neigiamų balsų (svorio koeficientų) suma buvo paversta į 10 balų vertinimo sistemą, kur blogiausias įvertinimas yra 0 balų, o geriausias – 10. Bendras LR Seimo frakcijų įvertinimas gautas išvedant vidurkį iš tabako ir alkoholio srities įvertinimų. Rezultatai. Sukūrus ir pritaikius LR Seimo narių balsavimų vertinimo instrumentą šešių 2012–2016 m. LR Seimo kadencijos sesijų laikotarpiui, nustatyta, kad viso per 57 balsavimus tabako ir alkoholio kontrolės politikos klausimais vidutiniškai balsavo 75 LR Seimo nariai (mažiausiai – 38; daugiausia – 114). Iš 146 įvertintų buvusių ir esamų LR Seimo narių 58 proc. buvo įvertinti mažiau nei 5 balais (neigiami įvertinimai), 27 proc. įvertinti 5–7 balais, 13 proc. – 8 balais ir 2 proc. – 9–10 balų. LR Seimo frakcijų įvertinimai atspindi įvertinimų sklaidą tarp joms priklausančių LR Seimo narių. Aukščiausi įvertinimai teko Lietuvos lenkų rinkimų akcijos ir Tėvynės sąjungos-Lietuvos krikščionių demokratų frakcijoms (atitinkamai 6,3 ir 5,9 balo). Darbo partijos bei „Tvarka ir teisingumas“ frakcijos vos viršijo teigiamo įverčio ribą (atitinkamai 5,1 ir 5,3 balo). Neigiami įvertinimai skirti Liberalų sąjūdžio frakcijai (2,3 balo), Lietuvos socialdemokratų partijos frakcijai (4,4 balo) bei Mišriai Seimo narių grupei (4,6 balo). Išvados. Įvertinus LR Seimo narių balsavimus, matyti dideli skirtumai tarp individualių LR Seimo narių balsų, priklausančių toms pačioms frakcijoms. Daugiau kaip pusė LR Seimo narių gavo neigiamus įvertinimus, kuriuos lėmė dažnas nedalyvavimas LR Seimo posėdžių balsavimuose

Analysis of problematic alcohol use among 15-74 years old Lithuanian population: results of audit test

gam alkoholio vartojimui nustatyti. Tyrimuose žalingas alkoholio vartojimas nustatomas apsibrėžiant saikingo alkoholio vartojimo ribą ir įvardijamas kaip probleminis alkoholio vartojimas ar tiesiog piktnaudžiavimas alkoholiu. Apibendrinant AUDIT testo rezultatus, šiame tyrime analizuojamas probleminio alkoholio vartojimo paplitimo Lietuvoje reiškinys 2007 m. Metodai. Reprezentatyvus 15–74 m. amžiaus Lietuvos gyventojų tyrimas buvo atliktas 2007 m. spalio- gruodžio mėnesiais. Anketą iš viso užpildė 3302 asmenys. Žalingo alkoholio vartojimo paplitimui įvertinti buvo panaudotas AUDIT klausimynas. Respondentų buvo papildomai paprašyta nurodyti demografinius duomenis bei išlaidas alkoholiniams gėrimams. Rezultatai. Penktadalis 15–74 m. amžiaus Lietuvos gyventojų alkoholį vartoja žalingai. Didžiausias žalingo alkoholio vartojimo paplitimas nustatytas 35–44 m. amžiaus vyrų ir 25–34 m. amžiaus moterų grupėse. Vyrams pavojingas alkoholio vartojimas nustatytas beveik 3 kartus dažniau nei moterims. Taip pat didesnis probleminio alkoholio vartojimo paplitimas nustatytas žemesnį išsilavinimą turinčių, kaimiškose vietovėse gyvenančių, bedarbių bei vienišų asmenų grupėse, o probleminiu alkoholinių gėrimų vartojimu pasižymintys asmenys per mėnesį išleisdavo vidutiniškai 4 kartus didesnę sumą alkoholinių gėrimų įsigijimui. Šis tyrimas parodė, kad alkoholio vartojimo problemos yra aktualios pakankamai didelei daliai Lietuvos gyventojų, o ypatingą susirūpinimą turėtų kelti tai, kad jau pačiose jauniausiose tiriamųjų amžiaus grupėse nustatytas didelis alkoholio vartojimo rizikos lygis.AUDIT test is a traditional methodology to diagnose harmful use of alcohol. The study summarizes the AUDIT test results from the public survey data which was performed in 2007. Methods. The representative sample of Lithuanian adult (15-74 years old) population has been surveyed in October-December 2007. In total 3302 respondents filled in the questionnaire. The level of harmful use of alcohol was estimated with the AUDIT test. The respondents were also asked to provide additional demographic information as well as information about their expenditure on alcoholic beverages. Results. The harmful use of alcohol was observed in 1/5 of 15-74 years old Lithuanians. The highest prevalence of harmful use of alcohol was among 35-44 years old males, and 25-34 years old females. It was around three times more common among males then among females. The lower education, unemployment, living in rural areas, and living alone were the factors more closely associated with the higher prevalence of problematic alcohol use. Problematic alcohol users spend in average 4 times more money to purchase alcoholic beverages. According to the study results alcohol related problems are associated with significant proportion of Lithuanian population. Special concern must be attributed to a fact that the problematic use of alcohol is high among the people in youngest age groups