If a minimum unit price of alcohol reduces alcohol-related call-outs…I'll drink to that!
Alcohol-related harm—whether acute or long-term—has provided a significant challenge for populations and healthcare services across the UK.
Around 24% of adults in the UK regularly drink in excess of the low-risk guidelines for alcohol and, in Scotland, there are higher sales of alcohol and incidents of alcohol-related harm than in the rest of the UK generally. In 2018, Scotland implemented a minimum pricing per unit of alcohol (MUP) in a bid to reduce consumption and the incidence of alcohol-related harm. Given that alcohol-related harm is higher in socioeconomically deprived areas, it was thought that the MUP would have most impact in those areas and thus reduce health inequalities in Scotland.
This controlled, interrupted time-series sought to measure the effect of MUP on alcohol-related ambulance call-outs after 20 months. The study team received data from the Scottish Ambulance Service for calls 3 years prior to and 2.5 years after MUP introduction. They used a control group of calls to people in the same areas as the study population but aged less than 13 years, as the policy was not expected to impact the outcome in this age group.
Alcohol-related call-outs followed a seasonal pattern with peaks at weekends and large peaks on New Year's Eve. There was less variation in call-outs for under 13-year-olds during the week, but noticeable seasonal changes. The distribution of sex and socioeconomic deprivation was similar in the two groups. Shockingly, 2.9% of alcohol-related call-outs were aged under 13; these records were removed from the analysis.
Unfortunately, the authors found no association between MUP implementation and variations in the daily volume of alcohol-related call-outs. They postulate reasons for their findings, with the most likely explanations being the lack of impact on dependent drinkers, and on prices in licensed premises, which were not impacted by MUP.
Can we legislate for bystander CPR?
Out-of-hospital cardiac arrest (OHCA) is a major public health issue with survival rates remaining stubbornly low. Bystander cardiopulmonary resuscitation (CPR) and use of automatedexternal defibrillators (AEDs) significantly increase survival. Many developed countries have therefore established CPR training for the public and public-access AEDs.
China is among the first developing countries to adopt a systemwide approach for improving the survival of patients with OHCA in pilot cities through implementation of legislation. In 2010, the pilot cities introduced CPR and AED training for the public and, in 2018, the governments of pilot cities enacted the Emergency Medical Aid Act to promote implementation of the programmes.
This observational cohort study analysed a prospective city registry of patients with bystander-witnessed OHCA between 1 January 2010 and 31 December 2022. An interrupted time-series analysis was used to assess changes in outcomes before and after the law.
A total of 13 751 patients with OHCA were included in the study (median [IQR] age, 59 [43–76] years; 10 011 men [72.83%]). In the pre-legislation period (1 January 2010–30 September 2018), 7858 OHCAs occurred, while 5893 occurred in the post-legislation period (1 October 2018–31 December 2022). The rates of bystander-initiated CPR increased significantly following implementation of the legislation compared with rates before the legislation. In the pre-legislation period, 4.10% received bystander CPR compared with 18.73% in the post-legislation period. Likewise, AED use rose from 4.12% to 5.29% and rates of prehospital return of spontaneous circulation (ROSC) improved from 0.92% to 7.21%. Survival to arrival at the hospital rose from 0.87% to 5.45%, and survival at discharge from 0.56% to 2.80%.
Changes were all statistically significantly and this interrupted time-series model demonstrated a significant slope change in the rates of all outcomes. The authors concluded that use of a system-wide approach to enact resuscitation initiatives and provide legal support may reduce the burden of OHCA in low- and middle-income settings.