Scotland: MUP for decreasing alcohol-related deaths

A minimum unit pricing legislation is associated with a significant reduction in alcohol-related deaths among people from the most socio-economically disadvantaged areas.

The MUP (Minimum Unit Pricing)

In May 2018, the Scottish Government introduced legislation (Minimum Unit Pricing - MUP) to set a minimum price of 50 pence per unit of alcohol (10 ml or 8 g of pure alcohol). The policy was intended to have an impact mainly on low-cost high-grade spirits and to reduce alcohol consumption among heavy drinkers. Previous studies indicate that the introduction of this policy reduced alcohol sales by 3%, with further research suggesting that the greatest reductions occurred in households that purchased the most alcohol. However, no previous study has examined whether this policy has led to a reduction in alcohol-specific deaths and hospitalisations nationally in Scotland.

Scotland has the highest alcohol-related mortality rate in the UK, and those living in the most socio-economically disadvantaged areas in Scotland experience mortality rates more than five times higher than those living in the least disadvantaged areas. The minimum unit price policy aims to address this inequality by reducing alcohol consumption, and thus health damage, in heavy drinkers who tend to buy the cheapest alcohol.

Minimum price per unit of alcohol decreases deaths

The results of the study indicate that the policy is having a positive impact on public health: its implementation is associated with fewer alcohol-related deaths in men and those living in the 40% most deprived areas of Scotland who die disproportionately from alcohol-related harm.

The researchers acquired information on alcohol-specific deaths and hospitalisations from Scottish and English databases before the introduction of the MUP legislation (January 2012 to April 2018) and two years and eight months later (May 2018 to December 2020). Data from England were used to form a control group, as the part of the UK where the legislation was not implemented. The researchers compared the variation in deaths and hospital admissions over the two periods between the two countries, taking into account various other factors, such as the level of government restrictions during the COVID-19 pandemic.

In the two years and eight months since the implementation of the MUP, the new policy has been associated with a 13.4% decrease in alcohol-related deaths, compared to an estimate of what would have occurred in the absence of the MUP legislation. These figures equate to approximately 150 alcohol-related deaths on average each year. Statistically significant reductions in alcohol-related deaths associated with the MUP were observed in those living in the most socio-economically disadvantaged 40% of Scotland.

The study also observed a 4.1% decrease in alcohol-related hospital admissions associated with the new policy, but this was not statistically significant.

The authors suggest that the overall reduction in alcohol-related deaths is due to a decrease in deaths from chronic diseases caused by alcohol consumption. The implementation of MUP was associated with an 11.7% reduction in deaths from alcoholic liver disease and a 23% reduction in deaths from alcohol dependence syndrome.

However, MUP was also associated with an increased rate of deaths and hospitalisations due to short-term conditions caused by alcohol consumption, such as alcohol poisoning, although these results were not statistically significant. The authors make it clear that short-term conditions contribute about 5% of alcohol-related deaths in Scotland and therefore these estimates have a large degree of uncertainty.

Overall, due to the impact of long-term conditions offsetting that of short-term conditions, the study finds a 13% reduction in alcohol-specific deaths associated with the minimum unit price, indicating that the MUP policy has an overall health benefit for Scottish citizens.

Wyper GMA, Mackay DF, Fraser C, Lewsey J, Robinson M, Beeston C, Giles L. Evaluating the impact of alcohol minimum unit pricing on deaths and hospitalisations in Scotland: a controlled interrupted time series study. Lancet. 2023 Mar 20:S0140-6736(23)00497-X. doi: 10.1016/S0140-6736(23)00497-X. Epub ahead of print. PMID: 36963415.