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Minimum Unit Alcohol Pricing Credited for Reducing Deaths in Scotland

New research has estimated that the minimum unit pricing of alcohol policy in Scotland has reduced deaths from alcohol consumption by 13%.

The minimum unit pricing (MUP) policy was implemented in May 2018, with every alcoholic drink sold in Scotland having to have an MUP of 50 pence per unit. The policy was intended mostly to impact low-cost high-strength alcohol and to reduce alcohol consumption in the heaviest drinkers.

"Scotland has the highest rate of death due to alcohol consumption in the UK, with those living in the most socioeconomically deprived areas in Scotland experiencing death rates more than five times higher compared to those living in the least deprived areas," explained Dr Grant Wyper, public health intelligence adviser at Public Health Scotland, and co-author.

The policy aimed to tackle this inequality by reducing alcohol consumption, and therefore "harms to health", in the heaviest drinkers who "tend to drink the cheapest products", highlighted Dr Wyper in a Science Media Centre (SMC) briefing. 

For the new study, published in The Lancet, researchers set out to "estimate the effect of alcohol minimum pricing legislation on deaths, and hospitalisations, wholly attributable to alcohol consumption, in Scotland", explained Dr Wyper.

The researchers, from Public Health Scotland, the University of Glasgow, and the University of Queensland, Australia, used data from Scotland and England on alcohol-specific deaths and hospitalisations prior to the introduction of MUP legislation (January 2012 to April 2018) and 2 years and 8 months afterwards (May 2018 to December 2020). Data from England was used to form a control group as a part of the UK where the legislation was not implemented. The researchers compared the change in deaths and hospitalisations in the two periods across the two countries, whilst accounting for various other factors such as the level of Government restrictions during the COVID-19 pandemic.

Wholly Attributable to Alcohol Consumption

The implementation of the legislation was associated with "significant reductions in alcohol-specific deaths" among those from the most socio-economically deprived areas in Scotland, commented the authors of the study, and added that the policy was having a "positive impact" on public health. Its implementation was associated with fewer alcohol-specific deaths in men and those living in the 40% most deprived areas of Scotland who were "disproportionately dying of alcohol related harms," said Dr Wyper.

There was a 13.4% reduction in deaths from alcohol consumption compared with an estimate, using data from England, of the deaths that would have occurred had the legislation not been implemented. This reduction was equivalent to "avoiding around 150 deaths per year", the authors pointed out.

"The reduction in alcohol-specific deaths was driven by a decrease in deaths from long-term conditions caused by alcohol consumption," emphasised the authors. This included an 11.7% reduction in deaths due to alcoholic liver disease, and a 23% reduction in deaths from alcohol dependence syndrome. 

The researchers also observed a 4.1% decrease in hospitalisations due to alcohol consumption associated with the policy, but this was not statistically significant, they said. 

During the 2 years and 8 months following implementation of the policy, the significant reductions in deaths, and reductions in hospitalisations, were "wholly attributable to alcohol consumption", said the authors. 

Although MUP was associated with an increase in the rate of deaths and hospitalisations due to short-term conditions caused by alcohol consumption, such as alcohol poisoning, these findings were not statistically significant, they explained. 

Measured Improvements

The authors concluded that their findings provided evidence that the MUP policy was having the intended effect of tackling health inequalities around harms from alcohol consumption, and that the policy had a benefit to the health of the Scottish public.

"Our study provides the best evidence to date to link minimum alcohol pricing in Scotland with a significant reduction in deaths from alcohol consumption in people living in the most socio-economically deprived areas in Scotland," said Ms Lucie Giles, public health intelligence principal at Public Health Scotland, and co-author.

Speaking to the SMC, Professor John Holmes, director of the Sheffield Alcohol Research Group, University of Sheffield, said that the study provided the "clearest" evidence to date that MUP had reduced the harm caused by alcohol in Scotland. "It is unlikely we would see the large effects reported in this study if heavier drinkers had not reduced their consumption," he said.

Mixed Feelings

The authors acknowledged some limitations of their study, including that there was an impact on hospital capacity and attendance during the COVID-19 pandemic, which increased the uncertainty of the study findings related to hospitalisations. 

Additionally, published estimates had indicated a recent worsening in alcohol-specific mortality in both Scotland and England. The study period did not include these recent data; however, the increase in the rate in Scotland from 2020 to 2021 (4%) was lower than in England (7%) and so the authors suggested it was therefore "unlikely that the inclusion of more recent data would have altered the main findings".

However, some experts raised concerns about the clarity of the findings. "In my view, there remains some doubt about whether MUP definitely caused the alcohol consumption change and therefore whether it is responsible for reductions in deaths," challenged Professor Kevin McConway, emeritus professor of applied statistics at the Open University, when he commented to the SMC. 

Also commenting to the SMC, Dr Adam Jacobs, senior director, biostatistical sciences at Premier Research, questioned the study findings and expressed concerns about the 13.4% reduction figure. He said that he would be "more convinced" with that figure if the authors had "presented statistics on all-cause mortality".

"It is plausible that the MUP policy would bring down deaths and hospitalisations due to alcohol consumption, but I don't think this paper shows it convincingly," he said.

Dr Sadie Boniface, head of research, Institute of Alcohol Studies, and visiting researcher, King's College London, cautioned that the study only looked at the first 32 months of minimum pricing in Scotland. Commenting to the SMC, she warned that, although previous evidence had suggested the health gains identified should continue into the future, "high levels of inflation risk watering down the impact of the policy as it currently stands".

Public Health Scotland, and the evaluation of alcohol minimum unit pricing legislation, is funded by the Scottish Government. GMAW, CF, CB, and LG report funding from the Scottish Government. All other authors declare no competing interests.