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

项目总结 直到最近，美国的预期寿命一直在增加。然而，在过去的几年里， 在经历了一段停滞期后，出生时预期寿命开始下降。这一趋势背后的原因是 社会经济地位低的个人在特定死因中的死亡率增加 受到不成比例的影响。死亡率上升的具体死因包括 中毒、自杀、与机动车有关的伤害、肝病和肝硬变以及糖尿病--所有这些 与饮酒有因果关系。酒精的使用也被发现与高死亡率有关。 SES低的个体中的风险。 这项拟议的项目将调查酒精使用在美国人预期寿命过去和未来趋势中的作用 无论是国家层面还是州级层面。选择了15个州作为状态级建模的基础 相关特征(例如，高死亡率)，覆盖所有九个人口普查分区和超过50%的人口普查 人口。潜在寿命损失年数(YLL)将作为主要结果衡量标准，因为它更接近 与预期寿命本身相关的因素比死亡率更大。该项目将1)调查社会经济地位和种族/族裔 利用国家健康访谈调查数据对饮酒与长寿关系的影响修正因素 与死因数据相关联；二)生成特定原因的酒精可归因性YLL的微观模拟模型 按社会经济地位、种族/族裔、年龄和性别分列(2002-2017年)；以及三)不同酒类的YLL模型收益 控制干预情景(2018-2028年)。微观模拟模型将基于来自 国家人口统计系统和当前人口调查的人口构成部分、曝光率 该部分将由全国酒精及相关流行病调查的数据提供信息 条件和行为风险因素监测系统。你因意外伤害，自杀，肝脏 疾病和肝硬变、糖尿病、缺血性心脏病、出血性中风和高血压心脏 疾病将在美国成人(18岁以上)普通人群中进行调查。具体原因 与酒精使用相关的死亡风险将考虑到SES和种族/民族的影响修改，如果 恰如其分。酒类征税、最低单价、酒类可获得性监管和 将模拟酒精消费和酒精可归因性死亡率的筛查和简短干预 在不同的场景下。 拟议的研究结果将直接为循证酒精控制干预措施提供信息 旨在降低酒精导致的死亡率，特别是在美国最脆弱的群体中 人口。此外，微观仿真模型还具有在未来进行扩展的潜力 包括其他州、干预措施和/或风险因素。

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.