The impact of increasing the minimum legal drinking age to 20 years in Lithuania on all-cause mortality- an interrupted time-series analysis

TLDR: Although there was a notable decline in all-cause mortality rates among young adults in Lithuania, a direct causal impact of MLDA on all- cause mortality rates in young adults was not definitively found.

Abstract: Aims To determine the effect of an alcohol policy change, which increased the minimum legal drinking age (MLDA) from 18 years of age to 20 years of age on all-cause mortality rates in young adults in Lithuania. Methods An interrupted time series analysis was conducted on a dataset from 2001 to 2019 (n = 228 months). The model tested the effects of the MLDA on all-cause mortality rates (deaths per 100,000 individuals) in 3 age categories (15-17 years old, 18-19 years old, 20-22 years old). Additional models that included GDP as a covariate and taxation policy were tested as well. Results There was a significant effect of the MLDA on all-cause mortality rates in those 18-19 years old, when modelled alone. Additional analyses controlling for the mortality rate of other age groups showed similar findings. Inclusion of confounding factors (policies on alcohol taxation, GDP) eliminated the effects of MLDA. Conclusions Although there was a notable decline in all-cause mortality rates among young adults in Lithuania, a direct causal impact of MLDA on all-cause mortality rates in young adults was not definitively found. Short Summary We investigated the effect of an increase in minimum legal drinking age (MLDA) on all-cause mortality in young adults (aged 18-19). MLDA had a negative effect on all-cause mortality (even when controlling for mortality rates in other age groups), however when confounding factors were included, these effects were attenuated.

Figures

Figure 1: Mortality rate in Lithuania in the age group 18- and 19-year-olds, 2000-2019 separated by 4 major death categories

Table 2: Estimated trends in mortality rates during four different periods of alcohol control policy in Lithuania

Table 1: Overview of ITS of MLDA (January 2018) on mortality rates controlling for time series of other populations

Full text

1
The impact of increasing the minimum legal drinking age to 20 years in
Lithuania on all-cause mortality – an interrupted time-series analysis
Alexander Tran PhD
1
, Huan Jiang PhD
1,2
, Shannon Lange, PhD
1,3
, Michael Livingston PhD
4-6
,
Jakob Manthey PhD
7-9
, Maria Neufeld MSc
1, 7, 10
, Robin Room PhD
4, 11
, Mindaugas Štelemėkas
PhD
12-13
, Tadas Telksnys PhD
12
, Janina Petkevičienė
12,13
, Ričardas Radišauskas
14,15
, Jürgen Rehm,
PhD
1-3,7,8,16-19
1. Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33
Ursula Franklin Street, Toronto, Ontario, Canada, M5S 2S1
2. Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto,
ON, M5T 1P8, Canada
3. Campbell Family Mental Health Research Institute, Centre for Addiction and Mental
Health, 33 Ursula Franklin Street, Toronto, Ontario, Canada, M5T 2S1
4. Centre for Alcohol Policy Research, Building NR-1, La Trobe University, Plenty Rd. x
Kingsbury Rd., Bundoora, Victoria 3086, Australia
5. National Drug Research Institute, Health Sciences, Curtin University, Perth, 6102,
Australia
6. Department of Clinical Neuroscience, Karolinska Institutet, Solnavägen 1, 171 77 Solna,
Sweden
7. Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden,
Chemnitzer Str. 46, 01187 Dresden, Germany
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)
The copyright holder for this preprint this version posted April 10, 2021. ; https://doi.org/10.1101/2021.04.07.21255080doi: medRxiv preprint
NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

2
8. Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and
Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52,
20246 Hamburg, Germany
9. Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10,
04103 Leipzig, Germany
10. WHO European Office for Prevention and Control of Noncommunicable Diseases,
Moscow, Leontyevsky Pereulok 9, 125009 Moscow, Russian Federation
11. Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences,
Stockholm University, 3rd floor, Sveavägen 160, 113 46 Stockholm, Sweden.
12. Health Research Institute, Faculty of Public Health, Lithuanian University of Health
Sciences, Tilžės str. 18, 47181 Kaunas, Lithuania
13. Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of
Health Sciences, Tilžės str. 18, 47181 Kaunas, Lithuania
14. Department of Environmental and Occupational Medicine, Faculty of Public Health, Lithuanian
University of Health Sciences, Tilžės str. 18, 47181 Kaunas, Lithuania
15. Institute of Cardiology, Lithuanian University of Health Sciences, Sukilėlių str. 17, 50162 Kaunas,
Lithuania.
16. World Health Organization / Pan American Health Organization Collaborating Centre,
Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario,
Canada, M5S 2S1
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)
The copyright holder for this preprint this version posted April 10, 2021. ; https://doi.org/10.1101/2021.04.07.21255080doi: medRxiv preprint

3
17. Faculty of Medicine, Institute of Medical Science, University of Toronto, Medical
Sciences Building, 1 King’s College Circle, Room 2374, Toronto, Ontario, Canada, M5S
1A8
18. Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto,
Ontario, Canada, M5T 1R8
19. Department of International Health Projects, Institute for Leadership and Health
Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya str., 8,
b. 2, 119992, Moscow, Russian Federation
Key words: alcohol - control policy – minimum legal drinking age – Lithuania – all-cause
mortality
Number of Tables: 2
Number of Figures: 1
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)
The copyright holder for this preprint this version posted April 10, 2021. ; https://doi.org/10.1101/2021.04.07.21255080doi: medRxiv preprint

RUNNING HEAD: Impact of minimum legal drinking age
4
Abstract
Aims: To determine the effect of an alcohol policy change, which increased the
minimum legal drinking age (MLDA) from 18 years of age to 20 years of age on all-cause
mortality rates in young adults in Lithuania.
Methods: An interrupted time series analysis was conducted on a dataset from 2001 to
2019 (n = 228 months). The model tested the effects of the MLDA on all-cause mortality rates
(deaths per 100,000 individuals) in 3 age categories (15-17 years old, 18-19 years old, 20-22
years old). Additional models that included GDP as a covariate and taxation policy were tested
as well.
Results: There was a significant effect of the MLDA on all-cause mortality rates in those
18-19 years old, when modelled alone. Additional analyses controlling for the mortality rate of
other age groups showed similar findings. Inclusion of confounding factors (policies on alcohol
taxation, GDP) eliminated the effects of MLDA.
Conclusions: Although there was a notable decline in all-cause mortality rates among
young adults in Lithuania, a direct causal impact of MLDA on all-cause mortality rates in young
adults was not definitively found.
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)
The copyright holder for this preprint this version posted April 10, 2021. ; https://doi.org/10.1101/2021.04.07.21255080doi: medRxiv preprint

RUNNING HEAD: Impact of minimum legal drinking age
5
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)
The copyright holder for this preprint this version posted April 10, 2021. ; https://doi.org/10.1101/2021.04.07.21255080doi: medRxiv preprint

Frequently asked questions

Q1. What have the authors contributed in "The impact of increasing the minimum legal drinking age to 20 years in lithuania on all-cause mortality – an interrupted time-series analysis" ?

The impact of increasing the minimum legal drinking age to 20 years in Lithuania on all-cause mortality was analyzed in this paper. 

Q2. What is the effect of a change in the minimum legal drinking age?

To determine the effect of an alcohol policy change, which increased theminimum legal drinking age (MLDA) from 18 years of age to 20 years of age on all-causemortality rates in young adults in Lithuania. 

Q3. Where is the Department of Preventive Medicine located?

Department of Environmental and Occupational Medicine, Faculty of Public Health, LithuanianUniversity of Health Sciences, Tilžės str. 18, 47181 Kaunas, Lithuania15.