The short-term impact of the alcohol act on alcohol-related deaths and hospital admissions in Scotland: a natural experiment

Background and aim: The introduction of the Alcohol Act in Scotland on 1 October 2011, which included a ban on multi-buy promotions, was likely associated with a fall in off-trade alcohol sales in the year after its implementation. The aim of this study was to test if the same legislation was associated with reduced levels of alcohol-related deaths and hospital admissions in the 3-year period after its introduction. Design: A natural experiment design using time series data to assess the impact of the Alcohol Act legislation in Scotland. Comparisons were made with unexposed populations in the rest of Great Britain. Setting Scotland with comparable data obtained for geographical control groups in other parts of Great Britain. Participants: For alcohol-related deaths, a total of 17,732 in Scotland and 88,001 in England/Wales across 169 four-week periods between January 2001 and December 2013. For alcohol-related hospital admissions, a total of 121,314 in Scotland and 696,892 in England across 182 four-week periods between January 2001 and December 2014. Measurements: Deaths and hospital admissions in Scotland and control groups that were wholly attributable to alcohol for consecutive four-week periods between January 2001 and December 2014. Data were obtained by age, sex and area-based socioeconomic position. Findings: There was no evidence to suggest that the Alcohol Act was associated with changes in the overall rate of alcohol-related deaths [incidence rate ratio (IRR) 0.99, 95% confidence interval (0.91 to 1.07)] or hospital admissions [IRR 0.98 (0.95 to 1.02)] in Scotland. In control group analyses, the pseudo intervention variable was not associated with a change in alcohol-related death rates in England/Wales [IRR 0.99 (0.95 to 1.02)], but was associated with an increase in alcohol-related hospital admission rates in England [IRR 1.05 (1.03 to 1.07)]. In combined models, the interaction analysis did not provide support for a ‘net effect’ of the legislation on alcohol-related deaths in Scotland compared with England/Wales [IRR 0.99 (0.95 to 1.04)], but suggested a net reduction in hospital admissions for Scotland compared with England [IRR 0.93 (0.87 to 0.98)]. Conclusion: The implementation of the Alcohol Act in Scotland has not been associated clearly with a reduction in alcohol-related deaths or hospital admissions in the 3-year period after it was implemented in October 2011