Change in alcohol outlet density and alcohol-related harm to population health (CHALICE): a comprehensive record-linked database study in Wales

摘要

Excess alcohol consumption has many adverse effects on health, including an increased risk of liver\udcirrhosis, gastrointestinal tract and breast cancers, high blood pressure and stroke. There is also an\udincreased risk of harm resulting from antisocial behaviour and violence. Binge drinking is a particular\udproblem, with the highest prevalence in the 16- to 24-year age group for women and men. Up to 40% of\udattendances at accident and emergency (A&E) departments and around half of all violent crimes in the UK\udare alcohol related.\udAround 37% of men and 25% of women exceeded UK guidelines for safe levels of alcohol consumption\udin 2014 (women more than three units per day; men more than four units per day) and 19% of men and\ud11% of women binge drink (women more than six units per day; men more than eight units per day).\udGiven the wide range of harm resulting from this substantial level of excess consumption, the potential\udimpact on health at the population level from a reduction in consumption is considerable.\udOne of the principal policies recommended by the British Medical Association to reduce alcohol\udconsumption is to reduce easy access to alcohol through controls on hours of sale and outlet density. This\uduses the availability theory of alcohol-related harm, which states that harmful outcomes are linked directly\udor indirectly to a greater availability of alcohol, through a higher density of alcohol outlets, leading to\udhigher consumption and hence alcohol-related harm.\udHowever, the evidence relating outlet density to alcohol-related harm is not consistent. Many cross-sectional\udstudies have suggested that high outlet densities are associated with a higher rate of a wide range of\udalcohol-related injuries. Fewer studies have investigated associations between outlet density and non-injury\udhealth outcomes, suggesting that high outlet densities are associated with high levels of consumption,\udsexually transmitted infections and alcohol-related hospital admissions. There have been few longitudinal\udstudies but these have provided limited evidence that an increase in outlet density is associated with\udincreased consumption and interpersonal violence and that a decrease in proximity to outlets is associated\udwith a small decrease in consumption. No longitudinal studies of admissions to hospital have been published\udfor non-violent outcomes. Many methodological questions remain over the best way to measure outlet\uddensity and how to model the relationship with alcohol-related harms. Little is known about the effects of\uda change in outlet density on inequalities in alcohol-related health and the role of population migration.