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Expanded Alcohol Screening and Brief Intervention to Address Premature Mortality
Julia M Lemp1,2, Carolin Kilian3,4,5, Xinyi Kou6
1Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.
Expanding alcohol screening and brief intervention (ASBI) in primary care can significantly reduce premature deaths from alcohol-related causes. Universal ASBI delivery shows the greatest potential for population health improvement and narrowing health disparities.
Area of Science:
- Public Health
- Preventive Medicine
- Health Services Research
Background:
- Alcohol use is a major cause of preventable mortality in the US.
- Alcohol screening and brief intervention (ASBI) in primary care is underutilized despite recommendations and coverage.
- Understanding the population-level impact of ASBI expansion is crucial for public health strategy.
Purpose of the Study:
- To estimate the impact of expanded ASBI delivery on alcohol consumption and potential years of life lost (YLL) from alcohol-related causes in US adults by 2030.
- To analyze these impacts across different demographic groups, including sex, race/ethnicity, and educational attainment.
- To evaluate the effectiveness of various ASBI expansion scenarios.
Main Methods:
- A decision-analytical study utilizing a dynamic, individual-level microsimulation model.
- The model simulated US adults (≥18 years) from 2000 to 2030, incorporating sociodemographic variables, alcohol use, and mortality risks.
- Four expansion scenarios for ASBI delivery were compared against a no-expansion counterfactual.
Main Results:
- Scenarios involving substantial expansion (8 million additional brief interventions or universal delivery) showed the most significant reductions in alcohol-related YLL.
- Universal ASBI delivery was projected to reduce annual alcohol-related YLL per 100,000 by -68.9 in men and -52.0 in women by 2030.
- The gap in YLL between low and high educational attainment groups narrowed with universal ASBI, indicating a modest potential to reduce socioeconomic inequalities.
Conclusions:
- Expanding ASBI delivery in primary care is a viable strategy to reduce premature mortality and improve population health.
- Substantial expansion of ASBI can measurably, though modestly, decrease socioeconomic disparities in premature mortality linked to alcohol use.
- The findings support increased implementation of ASBI programs within primary care settings.
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