Alcohol policies and alcohol-attributable cancer mortality in U.S. States
Research article
Abstract
Background
Although more restrictive alcohol control policies (e.g. higher alcohol taxes) are related to lower levels of alcohol consumption, little is known about the relationship between alcohol policies and rates of alcohol-attributable cancer.
Since alcohol control policies (e.g., alcohol taxes) can affect alcohol consumption, it is plausible that more restrictive policies may reduce alcohol-related cancer. However, the relationship between alcohol policies and mortality and incidence of alcohol-related cancers is unknown. Therefore, more restrictive alcohol policies constitute an overlooked but potentially impactful cancer prevention strategy.
Methods
State alcohol policy restrictiveness, as measured by a validated policy scale, were related to state rates of six alcohol attributable cancers in the U.S. from 2006 to 2010 in a lagged, cross-sectional linear regression that controlled for a variety of state-level factors. Cancer mortality rates were from the Center for Disease Control and Prevention’s Alcohol-Related Disease Impact application, which uses population-attributable fraction methodology to calculate mortality from cancers of the esophagus, larynx, liver, oropharynx, prostate (male only) and breast (female only).
Results
There was considerable variability in the restrictiveness of state policy environments during the study period. The distribution of average annual alcohol-attributable cancer mortality rates vary across the United States.
- Esophageal and liver cancers had the highest alcohol-attributable mortality rates.
- Esophageal cancer had the highest alcohol-attributable mortality rate among men.
- Breast cancer had the highest alcohol-attributable mortality rate among women.
More restrictive state alcohol policies were associated with lower cancer mortality rates for the six cancer types overall, and among men and women.
A 10% increase in the restrictiveness of alcohol policies was associated with an 8.5% decrease in rates of combined alcohol-attributable cancers. In all analyses stratified by cancer subtype and sex, the associations were in the hypothesized direction (i.e., more restrictive state policy environments were associated with lower rates of alcohol-attributable cancers), with the exception of laryngeal cancer among women.
Conclusion
This study is the first effort to examine the relationship between the restrictiveness of state alcohol polices and rates of alcohol-attributable cancer mortality in the U.S. Overall, states with more restrictive alcohol polices had lower rates of alcohol-attributable cancer mortality, including significant associations overall and for men and women for combined cancer mortality from all six cancers assessed.
Cancer is still a leading a cause of death in the U.S. Major cancer risk factors including obesity, smoking and alcohol are targeted through individual level interventions, but can also be targeted through population-level strategies.
More restrictive state alcohol policies were associated with lower rates of alcohol-attributable cancers. This suggests that strengthening alcohol control policies may be a promising cancer prevention strategy.
