Abstract：
OBJECTIVE: Alcohol pricing policies may reduce alcohol-related harms, yet little work has been done to model their effectiveness beyond health outcomes especially in Australia. We aim to estimate the impacts of four taxation and minimum unit pricing (MUP) interventions on selected social harms across sex and age subgroups in Australia.
METHODS: We used econometrics and epidemiologic simulations using demand elasticity and risk measures. We modelled four policies including (A) uniform excise rates (UER) (based on alcohol units) (B) MUP $1.30 on all alcoholic beverages (C) UER + 10 % (D) MUP$ 1.50. People who consumed alcohol were classified as (a) moderate (≤ 14 Australian standard drinks (SDs) per week) (b) Hazardous (15-42 SDs per week for men and 14-35 ASDs for women) and (c) Harmful (> 42 SDs per week for men and > 35 ASDs for women). Outcomes were sickness absence, sickness presenteeism, unemployment, antisocial behaviours, and police-reported crimes. We used relative risk functions from meta-analysis, cohort study, cross-sectional survey, or attributable fractions from routine criminal records. We applied the potential impact fraction to estimate the reduction in social harms by age group and sex after implementation of pricing policies.
RESULTS: All four modelled pricing policies resulted in a decrease in the overall mean baseline of current alcohol consumption, primarily due to fewer people drinking harmful amounts. These policies also reduced the total number of crimes and workplace harms compared to the current taxation system. These reductions were consistent across all age and sex subgroups. Specifically, sickness absence decreased by 0.2-0.4 %, alcohol-related sickness presenteeism by 7-9 %, unemployment by 0.5-0.7 %, alcohol-related antisocial behaviours by 7.3-11.1 %, and crimes by 4-6 %. Of all the policies, the implementation of a $1.50 MUP resulted in the largest reductions across most outcome measures.
CONCLUSIONS: Our results highlight that alcohol pricing policies can address the burden of social harms in Australia. However, pricing policies should just form part of a comprehensive alcohol policy approach along with other proven policy measures such as bans on aggressive marketing of alcoholic products and enforcing the restrictions on the availability of alcohol through outlet density regulation or reduced hours of sale to have a more impact on social harms.
METHODS: We used econometrics and epidemiologic simulations using demand elasticity and risk measures. We modelled four policies including (A) uniform excise rates (UER) (based on alcohol units) (B) MUP $1.30 on all alcoholic beverages (C) UER + 10 % (D) MUP$ 1.50. People who consumed alcohol were classified as (a) moderate (≤ 14 Australian standard drinks (SDs) per week) (b) Hazardous (15-42 SDs per week for men and 14-35 ASDs for women) and (c) Harmful (> 42 SDs per week for men and > 35 ASDs for women). Outcomes were sickness absence, sickness presenteeism, unemployment, antisocial behaviours, and police-reported crimes. We used relative risk functions from meta-analysis, cohort study, cross-sectional survey, or attributable fractions from routine criminal records. We applied the potential impact fraction to estimate the reduction in social harms by age group and sex after implementation of pricing policies.
RESULTS: All four modelled pricing policies resulted in a decrease in the overall mean baseline of current alcohol consumption, primarily due to fewer people drinking harmful amounts. These policies also reduced the total number of crimes and workplace harms compared to the current taxation system. These reductions were consistent across all age and sex subgroups. Specifically, sickness absence decreased by 0.2-0.4 %, alcohol-related sickness presenteeism by 7-9 %, unemployment by 0.5-0.7 %, alcohol-related antisocial behaviours by 7.3-11.1 %, and crimes by 4-6 %. Of all the policies, the implementation of a $1.50 MUP resulted in the largest reductions across most outcome measures.
CONCLUSIONS: Our results highlight that alcohol pricing policies can address the burden of social harms in Australia. However, pricing policies should just form part of a comprehensive alcohol policy approach along with other proven policy measures such as bans on aggressive marketing of alcoholic products and enforcing the restrictions on the availability of alcohol through outlet density regulation or reduced hours of sale to have a more impact on social harms.
摘要：
目标：酒精定价政策可能会减少与酒精有关的危害，然而，除了健康结果之外，对其有效性进行建模的工作很少，尤其是在澳大利亚。我们旨在估计四种税收和最低单位定价（MUP）干预措施对澳大利亚性别和年龄亚组中选定的社会危害的影响。
方法：我们使用了使用需求弹性和风险度量的计量经济学和流行病学模拟。我们对四项政策进行了建模，包括（A）统一消费税（UER）（基于酒精单位）（B）所有酒精饮料的MUP$1.30（C）UER10％（D）MUP$1.50。饮酒的人被归类为（a）中度（每周≤14种澳大利亚标准饮料（SDs））（b）有害（男性每周15-42个SDs，女性14-35个ASD）和（c）有害（男性每周>42个SDs，女性>35个ASD）。结果是疾病缺席，疾病出现，失业,反社会行为,和警方报告的犯罪。我们使用了荟萃分析的相对风险函数，队列研究,横断面调查，或常规犯罪记录中的可归因分数。我们应用潜在影响分数来估计实施定价政策后按年龄组和性别划分的社会危害减少情况。
结果：所有四个模型定价政策都导致当前酒精消费的总体平均基线下降，主要是由于更少的人饮用有害量。与目前的税收制度相比，这些政策还减少了犯罪和工作场所危害的总数。这些减少在所有年龄和性别亚组中是一致的。具体来说,病假减少了0.2-0.4%，与酒精有关的疾病出现7-9%，失业率下降0.5-0.7%，与酒精有关的反社会行为减少7.3-11.1％，犯罪率为4-6%。在所有的政策中,1.50美元的MUP的实施导致了大多数结果指标的最大削减。
结论：我们的研究结果强调，酒精定价政策可以解决澳大利亚的社会危害负担。然而,定价政策应该只是全面的酒精政策方法的一部分，以及其他行之有效的政策措施，如禁止积极营销酒精产品，通过出口密度监管或减少销售时间来加强对酒精供应的限制，以对社会危害产生更大的影响。
方法：我们使用了使用需求弹性和风险度量的计量经济学和流行病学模拟。我们对四项政策进行了建模，包括（A）统一消费税（UER）（基于酒精单位）（B）所有酒精饮料的MUP$1.30（C）UER10％（D）MUP$1.50。饮酒的人被归类为（a）中度（每周≤14种澳大利亚标准饮料（SDs））（b）有害（男性每周15-42个SDs，女性14-35个ASD）和（c）有害（男性每周>42个SDs，女性>35个ASD）。结果是疾病缺席，疾病出现，失业,反社会行为,和警方报告的犯罪。我们使用了荟萃分析的相对风险函数，队列研究,横断面调查，或常规犯罪记录中的可归因分数。我们应用潜在影响分数来估计实施定价政策后按年龄组和性别划分的社会危害减少情况。
结果：所有四个模型定价政策都导致当前酒精消费的总体平均基线下降，主要是由于更少的人饮用有害量。与目前的税收制度相比，这些政策还减少了犯罪和工作场所危害的总数。这些减少在所有年龄和性别亚组中是一致的。具体来说,病假减少了0.2-0.4%，与酒精有关的疾病出现7-9%，失业率下降0.5-0.7%，与酒精有关的反社会行为减少7.3-11.1％，犯罪率为4-6%。在所有的政策中,1.50美元的MUP的实施导致了大多数结果指标的最大削减。
结论：我们的研究结果强调，酒精定价政策可以解决澳大利亚的社会危害负担。然而,定价政策应该只是全面的酒精政策方法的一部分，以及其他行之有效的政策措施，如禁止积极营销酒精产品，通过出口密度监管或减少销售时间来加强对酒精供应的限制，以对社会危害产生更大的影响。
