Distance travelled to purchase alcohol and the mediating effect of price.

OBJECTIVES: Little research has been done into the distance travelled by consumers to purchase alcohol, whether this is influenced by demographic characteristics or drinking levels of consumers, and the effect of price on purchase distance. This study aimed to explore distances drinkers were prepared to travel to purchase alcohol at on- and off-site outlets and how these decisions were affected by price discounting. STUDY DESIGN: Online survey. METHODS: The study, including 831 alcohol consumers aged 18 years and older living in Australian capital cities, was undertaken in 2012. The survey was used to gather data on the distances which participants anticipated that they usually travelled to purchase alcohol. The data provided insight into which factors influence where participants would choose to purchase alcohol and the possible effects of price discounts on purchase distance. RESULTS: Most participants would choose to travel less than 10 km to purchase alcohol. Data indicated that price discounting might increase the purchase distance that most participants would be prepared to travel to purchase alcohol; this was more marked regarding off-site outlets and among high-risk drinking groups including young males and participants with risky drinking levels. CONCLUSIONS: Price discounting affects hypothetical purchase distance choices, indicating the importance of price when implementing alcohol control policies. Purchase distance might be more affected by price discounting among consumers visiting off-site outlets, but less useful when exploring associations with on-site outlets.

Alcohol use disorder hospitalisations over the last two decades: a population-based cohort study.

BACKGROUND: Alcohol use disorders are risk factors for almost all health conditions due to heavy alcohol use. The epidemiology of alcohol use disorders can be used to monitor harm from heavy alcohol consumption. AIM: To estimate changes in the risk of alcohol use disorders over the last two decades among the Western Australian adult population. METHODS: This population-based cohort study used hospital separation records for Western Australian residents aged 18 years and older that occurred between 1990 and 2013 with a primary diagnosis of alcohol use disorder and annual estimated residential population to estimate the annual gender- and age-specific incidence rate. A random sample of emergency presentations to public hospitals in Western Australia between 2002 and 2013 was used to account for confounding effects, such as changes in patient access to medical care and overall improvement in healthcare service in the multivariable Poisson regression model. RESULTS: The risk of alcohol use disorder hospitalisations among the Western Australia population has increased considerably since 1998 with a decline in 2012 and 2013. The average rate remained significantly higher from 2010 to 2013 compared with previous years. CONCLUSIONS: The trend of alcohol use disorder hospitalisations is indicative of an increase in harm due to heavy alcohol use in the population.

Alcohol consumption and health status of family members: health impacts without ingestion.

BACKGROUND: Over several decades, many cohort studies from the medical epidemiology literature have observed that compared with abstainers, moderate drinkers experience lower risk for a range of diseases. It was very difficult to separate the hypothesised physiological protective effect of moderate drinking from its well-correlated confounders in observational study settings. AIMS: To investigate the association between current alcohol consumption levels of randomly selected family members and the current self-reported health status of other members living within the same family, using a large-scale representative general population survey. METHOD: Poisson regression models of the association between randomly selected key respondent alcohol consumption and health status of cohabiting family members using data from the 2008, 2009 and 2010 National Health Interview Surveys. Self-reported alcohol consumption of randomly selected key participants and self-reported health status of adult and child (parent reported) family members living in the same household were measured and compared. RESULTS: After controlling for a large range of commonly reported confounders, inverse associations were evident between light and moderate alcohol consumption of key participants and the prevalence of adverse health status among their family members, including children. CONCLUSIONS: The superior health status attributed to family members of light and moderate drinkers is highly likely to be spurious and due to residual confounding rather than physiologically protective effects of alcohol. Unaccounted for confounding is likely to underpin apparent 'protective effects' due to moderate drinking commonly reported from observational studies of all-cause mortality, heart disease, stroke and other chronic diseases.

Mortality rate of alcoholic liver disease and risk of hospitalization for alcoholic liver cirrhosis, alcoholic hepatitis and alcoholic liver failure in Australia between 1993 and 2005.

BACKGROUND: Alcoholic liver disease (ALD) is an important contributor to the total burden of alcohol-related harm; however, the morbidity of different types of ALD in Australia has not been described. The aim of this study was to investigate recent trends in hospital admission rates among alcoholic liver cirrhosis, alcoholic hepatic failure and alcoholic hepatitis in Australia, as well as the mortality of ALD. METHOD: This is a population-based cohort study including the total 15+ years Australian population. Data were obtained from the Australian Bureau of Statistics and the Australian Institute of Health and Welfare. MAIN OUTCOME MEASURES: (i) trend of standardized mortality rates and trend of standardized hospital admission rates for males and females for 1993/1994-2004/2005 (fiscal year), (ii) relative risk of alcoholic liver cirrhosis, alcoholic hepatic failure and alcoholic hepatitis hospital admissions for 1999/2000-2004/2005. RESULTS: The mortality rate of ALD decreased significantly. Significant increases in hospital admissions for alcoholic hepatic failure among older adults and alcoholic hepatitis among younger age groups were observed. There is a significant 10-fold increase in the risk of hospital admissions of alcoholic cirrhosis in 2002/2003 for the 20-29 years population. CONCLUSION: Reductions in overall ALD mortality observed are likely the result of advances in disease management. Significant increase in hospital admissions suggests an increase in the prevalence of ALD among the Australian population. Dramatic increases in hospital admissions for alcoholic cirrhosis in 2002/2003 for the 20-29 years population may have been due to an increase in screening of alcohol-related harms in primary care settings.

Mortality and life-years lost due to alcohol: a comparison of acute and chronic causes.

OBJECTIVES: (i) To estimate the numbers of deaths and person-years of life lost (PYLL) due to high-risk alcohol consumption in Australia during 1997, using current estimates of consumption. (ii) To compare the number of deaths and PYLL due to acute conditions associated with bouts of intoxication and chronic conditions associated with long-term misuse of alcohol. METHODS: All Australian deaths during 1997 related to conditions considered to be partially or wholly caused by high-risk alcohol consumption were extracted from the Australian Bureau of Statistics Mortality Datafile and adjusted by alcohol aetiologic fractions calculated for Australia in 1997. A life-table method was used to estimate the PYLL for deaths from alcohol-caused conditions. MAIN OUTCOME MEASURES: Numbers of all deaths and PYLL due to chronic and acute alcohol-related conditions. RESULTS: Of the 3290 estimated alcohol-caused deaths in 1997, chronic conditions (eg, alcoholic liver cirrhosis and alcohol dependence) accounted for 42%, acute conditions (eg, alcohol-related road injuries and assaults) for 28% and mixed (chronic and acute) for 30%. Of the 62914 estimated potential life years lost, acute conditions were responsible for 46%, chronic for 33% and mixed for 21%. The average number of years of life lost through deaths from acute conditions was more than twice that from chronic conditions, because the former mostly involved younger people. CONCLUSIONS: In view of the societal burdens imposed by premature deaths, more effective public health strategies are needed to reduce the harm associated with occasional high-risk drinking (as well as sustained high-risk drinking), especially among young people.

Regional variation in alcohol consumption in the Northern Territory.

OBJECTIVE: To identify any regional variation in per capita consumption of alcohol and the types of beverages consumed in the NT; and to estimate the relative contributions to consumption by Aboriginal and non-Aboriginal people. METHOD: Per capita consumption estimates were based on wholesale purchases of alcohol by license and Census population data. Mean levels and the percentages of each beverage type consumed were compared between regions and through time. Estimates of per capita levels of consumption between Aboriginal and non-Aboriginal segments of the population were based on reports of the proportion of frequent and occasional drinkers in each group and the ratio of consumption among Aboriginal and non-Aboriginal drinkers. RESULTS: Mean quarterly per capita consumption was higher in both the Lower Top End (4.22 litres) and the Central NT (4.04 litres), and less in the Barkly (3.44 litres) than in the Top End (3.55 litres). Over the four-year period, consumption in the Top End rose 6.4%, but dropped 22.5% in the Barkly. In the Lower Top End and the Central NT a larger percentage of alcohol was consumed as cask wine than in the Top End. Before licensing restrictions were introduced, this was also the case in the Barkly. In the NT, per capita consumption among Aboriginal people is approximately 1.97 times, and among non-Aboriginal people about 1.43 times, the national average. CONCLUSIONS: Alcohol consumption in the NT is greater than in Australia as a whole and there is significant regional variation. The problem is not simply an Aboriginal problem, and a broad range of strategies--including a component to address regional variation--is required to reduce it.

The role of social and health statistics in measuring harm from alcohol.

Since excess use of alcohol contributes to so many varieties of health and social harms, in most countries, there are many potential sources of data indicative of alcohol-related harms. In few instances, compilation and interpretation of these data are straightforward, but, mostly, they are open to various sources of measurement error, which need to be taken into account if they are to be applied for research purposes. Police and health statistics are the major source of such information, but the underlying systems are not usually set up with the purpose of monitoring alcohol-related events. In both of these domains, types of events can be identified, which are wholly attributable to excess alcohol use, i.e. drunk-driving, alcoholic liver cirrhosis. Specific alcohol-related events are particularly prone to variations in, respectively, police enforcement practices, medical diagnostic fashion and sensitivity to prejudices about alcohol-related problems. A case will be made in this paper for the use of multiple surrogate measures of alcohol-related harm drawn from several sources in order to measure and track local, regional and national trends. For health statistics on mortality and morbidity, the aetiologic fraction (AF) method will be recommended for such monitoring purposes. It will also be recommended that these data be categorised by the degree to which cases are attributable to alcohol and also by whether the underlying hazardous drinking pattern is a brief drinking bout or a sustained pattern of heavy intake over a number of years. Nighttime occurrences of road crashes, public violence from both police and emergency room attendance data will also be recommended. It will be argued that routine recording of alcohol relatedness of events is usually unreliable, and the above surrogate measures are preferable. Recommendations will also be made for utilising national surveys of drinking behaviour to improve the calculation of alcohol-related morbidity and mortality, as well as refine estimates of per capita alcohol consumption, another major 'surrogate' measure of alcohol-related harm. The arguments will be illustrated with reference to Australia's National Alcohol Indicators Project and related research projects.

The Northern Territory's cask wine levy: health and taxation policy implications.

OBJECTIVE: To examine the effect of the application, and removal, in the Northern Territory of a levy on the sale of cask wine--a beverage shown to contribute disproportionately to alcohol-related harm. METHOD: Using data on licensee purchases of alcoholic beverages and ABS population data, estimates were made of per capita consumption of pure alcohol by beverage type. Time series variables were analysed using multiple linear regression analysis. RESULTS: Prior to the introduction of the levy, quarterly per capita consumption of cask wine among persons aged > or = 15 years was 0.73 litres. During the levy period, this fell to 0.49 litres and following removal of the levy rose to 0.58 litres. Imposition of the levy had no significant effect on the consumption of other beverages. CONCLUSIONS: Taxation is an effective means of reducing excessive alcohol consumption and related harm. IMPLICATIONS: In the interests of public health, support should be given to the introduction of a tiered tax based on alcohol content.