Deaths attributable to alcohol fall with rise in minimum price, study finds

BMJ 2013; 346 doi: (Published 07 February 2013) Cite this as: BMJ 2013;346:f825
  1. Jacqui Wise
  1. 1London

A 10% increase in the average minimum price of alcohol was associated with a 32% reduction in wholly alcohol attributable deaths, a Canadian study has found.1 The finding will lend support to the proposed introduction of a minimum price in England and Wales.2

The study, published in Addiction, analysed deaths associated with alcohol use in British Columbia between 2002 and 2009 and compared them with rises in government set prices for alcohol. The researchers used three categories of death associated with alcohol: wholly alcohol attributable, acute, and chronic. Wholly alcohol attributable deaths included alcohol poisoning, alcoholic psychoses, alcoholic cardiomyopathy, fetal alcohol syndrome, and chronic pancreatitis. Acute alcohol attributable deaths comprised mainly injuries, both intentional and unintentional. Chronic deaths included those from liver cirrhosis and various cancers, such as those of the mouth, oesophagus, and stomach.

Canada is one of only a handful of countries with set minimum prices for alcohol. Pricing is set by provincial governments, and British Columbia has set relatively low minimum prices. During the study period the minimum price for spirits rose from between $C25.91 and $C27 (£17.3; €20; $US27) per litre in August 2004 to $C30.66 in April 2009. The minimum price for beer also rose, from $C3 per litre in 2006 to $C3.54 in 2008, but the minimum price of other alcoholic drinks, such as wines, did not change over the study period.

Prices in Canada are set at a minimum price per litre without any reference to the strength of the drink. This differs from the UK proposals, which would set a minimum price for units of ethanol.

The proportion of deaths caused by alcohol in the province dropped more than expected, with a 1% increase in minimum price associated with a mortality decline of more than 3%. Although the study found an immediate reduction in the number of wholly alcohol attributable deaths, it found no immediate changes in acute or chronic alcohol attributable deaths. However, it found significant reductions in chronic deaths and in total deaths (all three categories added together) 2-3 years after the minimum price increases. The picture for acute alcohol attributable deaths was mixed, with some quarters showing a significant positive effect and some quarters a negative effect.

The study was complicated, because at the same time there was a substantial expansion in the number of alcohol retail outlets because of another provincial policy that came in gradually between 2002 and 2009. This allowed the part privatisation of alcohol retail sales; before this, alcohol could be sold directly to the public only in government stores. The researchers had therefore to control for this separate effect. They found that a 10% rise in the number of private liquor stores was associated with a 1.99% increase in the total alcohol attributable mortality rate.

The study’s author, Tim Stockwell, director of the Centre for Addictions Research at the University of Victoria, British Columbia, said, “This study adds to the scientific evidence that, despite popular opinion to the contrary, even the heaviest drinkers reduce their consumption when minimum alcohol prices increase. It is hard otherwise to explain the significant changes in alcohol related deaths observed in British Columbia.”


Cite this as: BMJ 2013;346:f825