Impacto de políticas de control de alcohol en las tasas de mortalidad por ictus hemorrágico e isquémico en Lituania: Análisis de series temporales interrumpidas Impact of alcohol control policy on hemorrhagic and ischemic stroke mortality rates in Lithuania: An interrupted time series analysis

Autores/as

  • Kawon Victoria Kim Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto ON Dalla Lana School of Public Health, University of Toronto, Toronto ON
  • Jürgen Rehm Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto ON, Canadá. Dalla Lana School of Public Health, University of Toronto, Toronto ON, Canadá. Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto ON, Canadá. Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Alemania. Department of Psychiatry, University of Toronto, Toronto ON, Canadá. Institute of Medical Science, University of Toronto, Toronto ON, Canadá. Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburgo, Alemania. Department of International Health Projects, Institute for Leadership and Health Management, L.M. Sechenov First Moscow State Medical University, Moscú, Federación Rusa.
  • Xinyang Feng Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto ON Dalla Lana School of Public Health, University of Toronto, Toronto ON
  • Huan Jiang Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto ON Dalla Lana School of Public Health, University of Toronto, Toronto ON
  • Jakob Manthey Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburgo Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig
  • Ričardas Radišauskas Department of Environmental and Occupational Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, 47181 Kaunas Institute of Cardiology, Lithuanian University of Health Sciences, 50162 Kaunas
  • Mindaugas Štelemėkas Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, 47181 Kaunas Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, 47181 Kaunas
  • Alexander Tran Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto ON
  • Anush Zafar Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto ON
  • Shannon Lange Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto ON Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto ON

DOI:

https://doi.org/10.20882/adicciones.1828

Palabras clave:

Alcohol, ictus, mortalidad, política sanitaria, Lituania. Alcohol, stroke, mortality, health policy, Lithuania.

Resumen

Dado el impacto del alcohol en los ictus, las políticas de control de alcohol deberían reducir las tasas de mortalidad. Nuestro objetivo fue demostrar el impacto de tres importantes políticas lituanas implementadas en 2008, 2017 y 2018 en las tasas de mortalidad específicas por subtipo de ictus y sexo, en mayores de 15 años. Se realizaron análisis de regresión «joinpoint» para identificar los cambios de tendencia. Para estimar el impacto, se realizaron análisis de series temporales interrumpidas utilizando un modelo mixto aditivo generalizado en las tasas mensuales estandarizadas por edad, desde enero 2001 hasta diciembre 2018. Se encontraron disminuciones porcentuales anuales promedio significativas en ambos subtipos de ictus y por sexo. Las políticas tuvieron un mayor impacto en las tasas de mortalidad por ictus isquémico en mujeres. Posterior a la política del 2008, ocurrió un cambio positivo de 4,498 muertes por ictus isquémico por 100 000 mujeres y un cambio de pendiente mensual negativo de -0,048 muertes por ictus isquémico por 100 000 mujeres. Posterior a las políticas de 2017 y 2018, hubo un cambio de tendencia negativo significativo para la mortalidad por ictus isquémico en mujeres, de -0.901 muertes y -1.431 muertes por 100 000 habitantes, respectivamente. La mortalidad por ictus hemorrágico en hombres no se vio afectada, y la mortalidad por ictus hemorrágico en mujeres y por ictus isquémico en hombres solo se vio afectada por la política del 2008. Nuestros hallazgos sugieren que el impacto de las políticas en la mortalidad por ictus puede variar según sexo y subtipo.
Given the causal impact of alcohol use on stroke, alcohol control policies should presumably reduce stroke mortality rates. This study aimed to test the impact of three major Lithuanian alcohol control policies implemented in 2008, 2017 and 2018 on sex- and stroke subtype-specific mortality rates, among individuals 15+ years-old. Joinpoint regression analyses were performed for each sex- and stroke subtype-specific group to identify timepoints corresponding with significant changes in mortality rate trends. To estimate the impact of each policy, interrupted time series analyses using a generalized additive mixed model were performed on monthly sex- and stroke subtype-specific age-standardized mortality rates from January 2001-December 2018. Significant average annual percent decreases were found for all sex- and stroke subtype-specific mortality rate trends. The alcohol control policies were most impactful on ischemic stroke mortality rates among women. The 2008 policy was followed by a positive level change of 4,498 ischemic stroke deaths per 100,000 women and a negative monthly slope change of -0.048 ischemic stroke deaths per 100,000 women. Both the 2017 and 2018 policy enactment timepoints coincided with a significant negative level change for ischemic stroke mortality rates among women, at -0.901 deaths and -1.431 deaths per 100,000 population, respectively. Hemorrhagic stroke mortality among men was not affected by any of the policies, and hemorrhagic stroke mortality among women and ischemic stroke mortality among men were only associated with the 2008 policy. Our study findings suggest that the impact of alcohol control policies on stroke mortality may vary by sex and subtype. 

Biografía del autor/a

Shannon Lange, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto ON Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto ON

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Publicado

2023-03-15

Número

Vol. 36 Núm. 2 (2024)

Sección

Originales