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• Study indicates the alcohol minimum unit pricing policy implemented in May 2018 in Scotland is linked to significantly fewer deaths caused by alcohol consumption, compared to an estimate of what would have occurred in the absence of the policy.
• Estimated reductions in alcohol-specific deaths were significant for those living in the most socio-economically deprived 40% of Scotland.
• Analysis suggests around 150 deaths per year in Scotland may have been prevented on average due to alcohol minimum unit pricing.
• Authors say this study provides evidence that the minimum unit pricing policy is having the intended effect of tackling health inequalities around harms from alcohol consumption. 

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A recent study published in The Lancet proposes that enforcing minimum unit pricing (MUP) laws causes noteworthy decreases in alcohol-related deaths among individuals residing in Scotland's most economically disadvantaged regions.

During the 32 months following the enforcement of the policy, alcohol-related deaths in Scotland decreased by 13% compared to a projected estimate, based on data from England, of the number of deaths that would have taken place in the absence of the legislation. This 13% reduction is equivalent to averting roughly 150 fatalities annually.

In May 2018, the Scottish government enacted legislation mandating a minimum price of 50 pence per unit of alcohol, which equates to 10 milliliters or 8 grams of pure alcohol. The primary objective of the policy was to impact inexpensive, high-strength alcohol and to reduce alcohol consumption among heavy drinkers. Prior research has shown that the policy's introduction caused a 3% decline in alcohol sales [1]. Further studies indicate that the most significant reductions occurred in households that previously bought the most alcohol. However, no prior research has examined if the policy resulted in reductions in alcohol-specific hospitalizations and deaths at the national level in Scotland.

Wider evidence on the extent to which MUP has had an impact in Scotland will be provided to members of the Scottish Parliament ahead of the parliamentary vote on the future of MUP in Scotland in 2024.

“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. [2] The minimum unit pricing policy aims to tackle this inequality by reducing alcohol consumption, and therefore harms to health, in the heaviest drinkers who tend to buy the least expensive alcohol. Our findings indicate the policy is having a positive impact on public health - its implementation is associated with fewer alcohol-specific deaths in men and those living in the 40% most deprived areas of Scotland who are disproportionately dying of alcohol related harms,” says Dr Grant Wyper, Public Health Intelligence Adviser at Public Health Scotland [3]. 

The research team collected data on alcohol-specific deaths and hospitalizations in Scotland and England from January 2012 to April 2018, before the MUP legislation was introduced, and from May 2018 to December 2020, two years and eight months after its implementation. Data from England was used as a control group, as the legislation was not enacted in that part of the UK. The researchers analyzed the changes in deaths and hospitalizations between the two periods across both countries, while taking into account several other factors, such as the level of government restrictions during the COVID-19 pandemic.

After the MUP policy was implemented, there was a 13.4% reduction in deaths caused by alcohol consumption over a period of two years and eight months. This decrease was compared to an estimate of what would have happened if the policy had not been implemented. On average, the reduction in alcohol-related deaths equated to approximately 150 fatalities per year. The reductions in alcohol-specific deaths associated with MUP were statistically significant and were observed primarily in individuals residing in the most socio-economically deprived 40% of Scotland.

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

The authors of the study suggest that the reduction in alcohol-specific deaths is primarily due to a decrease in deaths resulting from long-term conditions caused by alcohol consumption. They found that the implementation of MUP was associated with an 11.7% decrease in deaths due to alcoholic liver disease and a 23% decrease in deaths resulting from alcohol dependence syndrome.

Nevertheless, MUP was linked to an elevation in the rate of deaths and hospitalizations attributable to short-term conditions triggered by alcohol consumption, such as alcohol poisoning, although these outcomes were not statistically significant. The authors explain that short-term conditions account for approximately 5% of alcohol-specific deaths in Scotland, and as a result, these approximations have considerable associated uncertainty. The broader assessment of the policy has revealed some potential mechanisms that could lead to quicker intoxication and clarify these results, such as the replacement of food consumption with alcohol due to the financial pressures of the policy. The authors suggest that these findings emphasize the significance of ensuring timely, accessible services for those addicted to alcohol alongside the implementation of population-level policies like minimum unit pricing. Despite the impact of short-term conditions, the study reveals a 13% decrease in alcohol-specific deaths associated with minimum unit pricing, implying that the policy provides an overall benefit to the health of the Scottish populace.

The authors of the study recognize certain limitations, such as the impact of COVID-19 on hospital capacity and attendance, which adds to the uncertainty of the study's hospitalization findings. Furthermore, recent estimates suggest a deterioration in alcohol-specific mortality rates in both Scotland and England. However, the study did not cover this period. Nonetheless, the authors suggest that the rise in Scotland's rate from 2020 to 2021 (4%) was lower than that in England (7%), indicating that the inclusion of more recent data is unlikely to have affected the primary findings.

Ms Lucie Giles, Public Health Intelligence Principal at Public Health Scotland, states that in 2021, Scotland had the highest number of alcohol-specific deaths since 2008, indicating a concerning trend of decreasing improvements in life expectancy and increasing inequalities. However, the study provides robust evidence of the effectiveness of minimum alcohol pricing in Scotland, resulting in a significant reduction in deaths caused by alcohol consumption, particularly in the most socio-economically deprived areas of Scotland.

Dr Sarah Callinan and Dr Amy Pennay, researchers from La Trobe University, Australia, who were not involved in this study, wrote a Linked Comment. They noted that the research by Wyper and colleagues demonstrates that minimum unit pricing has reduced the inequalities in alcohol-related harm by reducing the harm experienced by individuals in lower socio-economic groups. This highlights the policy's effectiveness in targeting vulnerable populations. However, they also emphasized the need to address the underlying social inequalities that cause significant health harms. They called for continued efforts to acknowledge, research, and advocate for policies that tackle inequality.

NOTES TO EDITORS

This study was funded by Public Health Scotland. Public Health Scotland, and the evaluation of alcohol minimum unit pricing legislation, is funded by the Scottish Government. The study was conducted by researchers from Public Health Scotland, the University of Glasgow and the University of Queensland.

[1] Evaluating the impact of Minimum Unit Pricing on sales-based alcohol consumption in Scotland at three years post-implementation. 
[2] Alcohol-specific deaths in Scotland. 2021. 
[3] Quote direct from author and cannot be found in the text of the Article.
[4] 

The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence.