Alcohol policy and alcohol-related disease burden in Eastern EU countries: A longitudinal study

Abstract Introduction This study examines alcohol policy restrictiveness in Eastern European Union (EU) countries-Bulgaria, Croatia, Czechia, Hungary, Poland, Romania, Slovakia and Slovenia-a region with high alcohol consumption, especially among men. Using a modified Bridging the Gap (BtG-M) scale to measure alcohol policy restrictiveness, we analysed its association with alcohol consumption and alcohol-attributable disease burden. Methods Data on alcohol policy were collected from national legal documents and scored using the BtG-M scale, where higher scores indicate more restrictive alcohol policies. Disease burden measures were obtained from the Global Burden of Disease database. Data on total per capita alcohol consumption (APC) were obtained from the World Health Organization. Associations between BtG-M scores and outcomes were analysed using Spearman's Rank correlation and panel regression models. Results Poland maintained the highest level of restrictiveness, while Bulgaria, Croatia and Slovenia started with lowest scores, although Croatia and Slovenia increased their policy restrictiveness after 2000. Alcohol-attributable disease burden, but not total APC, was inversely associated with policy changes. However, the associations were complex: BtG-M scores correlated negatively with both disease burden and total APC only in Croatia, Czech Republic, Romania and Slovenia, and not in the other four countries. Conclusions To our knowledge, this study provides the first comprehensive evaluation of the link between changes in alcohol policy and alcohol-attributable disease burden in Eastern EU countries. We found a complex relationship: in half of the investigated countries, stricter alcohol policies were associated with lower levels of alcohol consumption and related disease burden. In the remaining countries, societal, cultural, demographic and economic factor beyond the scope of the alcohol policy scale appear to have a greater impact on policy effectiveness. Key messages • Despite the complex interplay between alcohol policy restrictiveness and alcohol-related disease burden, we found an association in the Eastern European Union countries. • To our knowledge, this is the first study assessing the longitudinal association between alcohol policy and disease burden in this region.