Over the years state legislators in the United States have passed a number of policies aimed at limiting the consumption of alcohol in an effort to reduce health and public safety issues.
A new study suggests that these policies are working, at least when it comes to cirrhosis, the final stage of alcoholic liver disease.
Researchers from Boston Children’s Hospital and other institutions found that states with tougher alcohol policies — such as taxes, restrictions on retail pricing, regulating the hours of sale, and limiting retail signage and media advertising — had lower death rates from alcohol-related cirrhosis.
For every 10-point increase in the strength of a state’s policies as calculated on an Alcohol Policy Scale score, cirrhosis deaths dropped by 11 percent (the numbers did not include people of American Indian or Alaska Native descent).
The bulk of the change was due to an 18 percent decrease in deaths among women, indicating that state alcohol policies may be more effectively targeting women than men.
To put these policy differences in perspective, states were ranked on a scale of 1 to 100 for the strength of alcohol laws, with their scores ranging from 23 (weakest) to 66 (strongest) during the study period of 1999 to 2008.
The findings were today in the journal Preventing Chronic Disease.
Binge Drinking and Cirrhosis Tied to Policies
After alcohol reaches the bloodstream from the stomach or intestines, it is processed by the liver, which can handle about one drink per hour.
Although the liver’s job is to break down the alcohol, this organ can also be damaged in the process, leading to inflammation, scarring, and cirrhosis.
Previous research has shown that overall was closely tied to the number of deaths from alcohol-related cirrhosis.
Among other things, state policies on alcohol sales and distribution are designed to reduce these types of health effects. Previous research shows that the policies can be effective.
“This new study is consistent with a decades-long literature of hundreds of studies in its main finding,” Alexander Wagenaar, Ph.D., a professor of health outcomes and policy at the University of Florida College of Medicine, told Healthline. “Regulation of the distribution and sales of alcoholic beverages leads to lower rates of disease, injury, and death.”
One key policy change was the raising of the drinking age from 18 to 21 by all states a few decades ago. This was followed by a decrease in teenage drinking, car crashes, and alcohol-related deaths.
Alcohol taxes also affect consumption rates.
”Hundreds of scientific analyses over the past half-century demonstrate that higher alcohol taxes lead to reductions in traffic crashes, cirrhosis disease, sexually transmitted infections, and many other alcohol-related causes of illness or death,” said Wagenaar.
Most previous research, though, focused on the effect of changing a single alcohol policy on public health. The new study looked at the cumulative effects of all alcohol policies working together.
Policies Affect Some Groups Differently
Using a similar method, two earlier studies in 2014 and found that stronger alcohol policies were tied to lower rates of binge drinking.
Binge drinking is a risk factor for developing alcoholic cirrhosis. According to the Centers for Disease Control and Prevention, about four times a month, with about eight drinks per binge.
In the new study, the researchers found that death rates from alcoholic cirrhosis among people of American Indian and Alaska Native descent weren’t affected as much by stronger state alcohol policies.
The authors say this may indicate that state policies are not reaching these people, who often live in tribal areas not governed by state laws or in remote locations.
In addition, the state policy rankings do not factor in federal or local policies, or how well state policies are enforced. This could explain some of the variation among states in the association between alcohol policies and death rates from alcoholic cirrhosis.
While alcohol policies appear to be improving public health, the authors of the new study echo the call for further research.
“Stronger alcohol policy environments are associated with lower alcoholic cirrhosis mortality rates,” they wrote in the paper. “Future studies should identify underlying reasons for racial/ethnic and regional differences in this relationship.”