A microsimulation of alcohol control interventions to advance health equity and reverse the current decrease in life expectancy in the US

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PROJECT SUMMARY Until recently, life expectancy in the United States (US) had been increasing. However, in the past couple of years, life expectancy at birth started to decline, following a period of stagnation. Underlying this trend are increases in mortality rates in specific causes of death, with individuals with low socioeconomic status (SES) being disproportionately affected. The specific causes of death for which mortality rates have increased include poisoning, suicide, motor vehicle-related injuries, liver disease and cirrhosis and diabetes mellitus—all of which are causally linked to alcohol use. Alcohol use has also been found to be associated with heightened mortality risk among individuals with a low SES. The proposed project will investigate the role of alcohol use in past and future trends in US life expectancy on both the national and state level. Fifteen states have been selected for the state-level modeling based on relevant characteristics (e.g., high mortality rates), covering all nine census divisions and more than 50% of the population. Years of potential life lost (YLL) will serve as the primary outcome measure, as it is more closely related to life expectancy per se than mortality rates. The project will I) investigate SES and race/ethnicity as effect modifiers on the relationship between alcohol use and YLL using National Health Interview Survey data linked to cause of death data; II) generate a microsimulation model of cause-specific alcohol-attributable YLL by SES, race/ethnicity, age and sex (for years 2002-2017); and III) model gains in YLL for different alcohol control intervention scenarios (for years 2018-2028). The microsimulation model will be based on data from the National Vital Statistics System and Current Population Surveys for the demographic component, the exposure component will be informed by data from the National Epidemiologic Survey on Alcohol and Related Conditions and the Behavioral Risk Factor Surveillance System. YLL from unintentional injuries, suicide, liver disease and cirrhosis, diabetes mellitus, ischemic heart disease, hemorrhagic stroke and hypertensive heart disease will be investigated among the adult (18+ years of age) general population of the US. Cause-specific mortality risks related to alcohol use will account for effect modification by SES and race/ethnicity, if appropriate. The effects of alcohol taxation, minimum unit pricing, regulation of the availability of alcohol and screening and brief intervention on alcohol consumption and alcohol-attributable mortality will be modeled under different scenarios. The findings of the proposed study will directly inform evidence-based alcohol control interventions with the aim of reducing alcohol-attributable mortality, particularly among the most vulnerable groups of the US population. Furthermore, the microsimulation model will have the potential to be expanded in the future in order to include additional states, interventions and/or risk factors.