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Impact of Minimum Unit Pricing on Alcohol-Related Emergency Department Attendances in Scotland: A Natural Experiment Study

44 Pages Posted: 28 Oct 2020

See all articles by Vivian So

Vivian So

University of Glasgow - MRC/CSO Social and Public Health Sciences Unit

Andrew D. Millard

University of Glasgow - MRC/CSO Social and Public Health Sciences Unit

Srinivasa Vittal Katikireddi

University of Glasgow - Institute of Health and Wellbeing

Paolo Deluca

King's College London - National Addiction Centre

Colin Drummond

King's College London - National Addiction Centre

Douglas Eadie

University of Stirling - Institute for Social Marketing and Health

Niamh Fitzgerald

University of Stirling - Institute for Social Marketing and Health

Allison Ford

University of Stirling - Institute for Social Marketing and Health

Ross Forsyth

University of Glasgow - MRC/CSO Social and Public Health Sciences Unit

Lesley Graham

NHS National Services Scotland - Information Services Division

Shona Hilton

University of Glasgow - MRC/CSO Social and Public Health Sciences Unit

Anne Ludbrook

University of Aberdeen - Health Economics Research Unit

Gerry McCartney

Public Health Scotland

Oarabile Molaodi

University of Glasgow - MRC/CSO Social and Public Health Sciences Unit

Michele Open

Royal Infirmary of Edinburgh

Lynn Owens

NHS Foundation Trust - Liverpool University Hospitals NHS Foundation Trust (LUH)

Samantha Perry

Government of the United Kingdom - Glasgow Royal Infirmary

Thomas Phillips

University of Hull - Institute for Clinical and Applied Health Research (ICAHR)

Martine Stead

University of Stirling - Institute for Social Marketing and Health

Chris Yap

Government of the United Kingdom - Sheffield Teaching Hospitals

Lyndal Bond

Victoria University - Mitchell Institute

Alastair Leyland

University of Glasgow - MRC/CSO Social and Public Health Sciences Unit

More...

Abstract

Background: Minimum Unit Pricing (MUP) was introduced in Scotland at 50p per unit (8g) of alcohol on 1st May 2018 to reduce alcohol consumption and associated harms. We assessed its impact on alcohol-related emergency department (ED) attendances, drinking patterns, and having an alcohol-related diagnosis amongst ED attendees. 

Methods: We used a natural experiment approach to compare outcomes between Scotland (intervention group) and England (comparison group). Two EDs in Scotland and two in England were recruited for one baseline and two post-intervention waves. Research nurses considered all attendees for interview, and recorded reasons for not interviewing attendees. The primary outcome was alcohol-related attendances among all recorded attendees. Secondary outcomes included alcohol-related diagnosis, binge drinking and high-risk drinking, and tested for differential effects across socioeconomic groups. Difference-in-difference regression models adjusted for age, sex and baseline covariates. 

Findings: 12,207 participants were recruited in Scotland and 11,248 in England. The odds ratio for an alcohol-related attendance was 1.14 (95% CI 0.90-1.44) after the introduction of MUP in Scotland relative to England, after controlling for covariates. It is estimated that an additional 1.0% (95% CI -0.7% to 2.7%) of the ED attendances were alcohol-related than would have been the case in the absence of MUP. Meanwhile, the odds for an attendee having at least one alcohol-related diagnosis increased after MUP (OR=1.25, 95%CI 1.00-1.57). There was no evidence of substantive differences in the majority of other secondary outcomes after the introduction of MUP in Scotland, or of differential effects across socioeconomic groups. 

Interpretation: We found no evidence that MUP impacted on alcohol-related ED attendances. 

Funding: NIHR, MRC, CSO

Declaration of Interests: GM and LG are members of the Scottish-Government funded Monitoring and Evaluating Scotland’s Alcohol Strategy (MESAS) evaluation.All other authors have no competing interests.

Ethics Approval Statement: Ethical approval has been obtained from the NHS through the Scotland A Research Ethics Committee, REC reference is 12/SS/0121.

Keywords: public health, minimum unit price, alcohol policy, difference-in-difference, natural experiment

Suggested Citation

So, Vivian and Millard, Andrew D. and Katikireddi, Srinivasa Vittal and Deluca, Paolo and Drummond, Colin and Eadie, Douglas and Fitzgerald, Niamh and Ford, Allison and Forsyth, Ross and Graham, Lesley and Hilton, Shona and Ludbrook, Anne and McCartney, Gerry and Molaodi, Oarabile and Open, Michele and Owens, Lynn and Perry, Samantha and Phillips, Thomas and Stead, Martine and Yap, Chris and Bond, Lyndal and Leyland, Alastair, Impact of Minimum Unit Pricing on Alcohol-Related Emergency Department Attendances in Scotland: A Natural Experiment Study. Available at SSRN: https://ssrn.com/abstract=3697993 or http://dx.doi.org/10.2139/ssrn.3697993

Vivian So (Contact Author)

University of Glasgow - MRC/CSO Social and Public Health Sciences Unit ( email )

Glasgow
United Kingdom

Andrew D. Millard

University of Glasgow - MRC/CSO Social and Public Health Sciences Unit ( email )

Glasgow
United Kingdom

Srinivasa Vittal Katikireddi

University of Glasgow - Institute of Health and Wellbeing ( email )

Glasgow
United Kingdom

Paolo Deluca

King's College London - National Addiction Centre ( email )

Strand
London, England WC2R 2LS
United Kingdom

Colin Drummond

King's College London - National Addiction Centre ( email )

Strand
London, England WC2R 2LS
United Kingdom

Douglas Eadie

University of Stirling - Institute for Social Marketing and Health ( email )

Stirling, Scotland FK9 4LA
United Kingdom

Niamh Fitzgerald

University of Stirling - Institute for Social Marketing and Health ( email )

Stirling, Scotland FK9 4LA
United Kingdom

Allison Ford

University of Stirling - Institute for Social Marketing and Health ( email )

Stirling, Scotland FK9 4LA
United Kingdom

Ross Forsyth

University of Glasgow - MRC/CSO Social and Public Health Sciences Unit ( email )

Glasgow
United Kingdom

Lesley Graham

NHS National Services Scotland - Information Services Division ( email )

Scotland
United Kingdom

Shona Hilton

University of Glasgow - MRC/CSO Social and Public Health Sciences Unit ( email )

Glasgow
United Kingdom

Anne Ludbrook

University of Aberdeen - Health Economics Research Unit ( email )

Dunbar Street
Aberdeen, Scotland AB24 3QY
United Kingdom

Gerry McCartney

Public Health Scotland ( email )

Scotland
United Kingdom

Oarabile Molaodi

University of Glasgow - MRC/CSO Social and Public Health Sciences Unit ( email )

Glasgow
United Kingdom

Michele Open

Royal Infirmary of Edinburgh

51 Little France Cres
Edinburgh, EH16 4SA
United Kingdom

Lynn Owens

NHS Foundation Trust - Liverpool University Hospitals NHS Foundation Trust (LUH) ( email )

United Kingdom

Samantha Perry

Government of the United Kingdom - Glasgow Royal Infirmary

Glasgow
United Kingdom

Thomas Phillips

University of Hull - Institute for Clinical and Applied Health Research (ICAHR) ( email )

Cottingham Road
Hull, Great Britain HU6 7RX
United Kingdom

Martine Stead

University of Stirling - Institute for Social Marketing and Health ( email )

Stirling, Scotland FK9 4LA
United Kingdom

Chris Yap

Government of the United Kingdom - Sheffield Teaching Hospitals ( email )

Sheffield
United Kingdom

Lyndal Bond

Victoria University - Mitchell Institute ( email )

Footscray Park
PO Box 14428
Melbourne, 8001
Australia

Alastair Leyland

University of Glasgow - MRC/CSO Social and Public Health Sciences Unit ( email )

Glasgow
United Kingdom

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