The Impact of alcohol taxation increase on all-cause mortality inequalities in Lithuania: an interrupted time series analysis

ENBackground: Taxation increases which reduce the afordability of alcohol are expected to reduce mortality inequalities. A recent taxation increase in Lithuania ofers the unique possibility to test this hypothesis. Methods: Census-linked mortality data between 2011 and 2019 were used to calculate monthly sex- and education stratifed age-standardized mortality rates for the population aged 40 to 70 years. As primary outcome, we analysed the diference in age-standardized all-cause mortality rates between the population of lowest versus highest educational achievement. The impact of the 2017 taxation increase was evaluated using interrupted time series analyses. To identify whether changes in alcohol use can explain the observed efects on all-cause mortality, the education-based mortality diferences were then decomposed into n=16 cause-of-death groupings. Results: Between 2012 and 2019, education-based all-cause mortality inequalities in Lithuania declined by 18% among men and by 14% among women. Following the alcohol taxation increase, we found a pronounced yet temporary reduction of mortality inequalities among Lithuanian men (−13%). Subsequent decomposition analyses suggest that the reduction in mortality inequalities between lower and higher educated men was mainly driven by narrowing mortality diferences in injuries and infectious diseases. Conclusions: A marked increase in alcohol excise taxation was associated with a decrease in mortality inequalities among Lithuanian men. More pronounced reductions in deaths from injuries and infectious diseases among lower as compared to higher educated groups could be the result of diferential changes in alcohol use in these populations. Keywords: Mortality inequality, Health inequality, Alcohol control policy, Alcohol taxation, Lithuania. [From the publication]

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