Expanded alcohol screening and brief intervention to address premature mortality

Importance: Alcohol use is a leading cause of premature mortality in the US. Despite public health recommendations and insurance coverage mandates, alcohol screening and brief intervention (ASBI) in primary care remains underused.

Objective: To estimate the population-level impact of expanded ASBI delivery on alcohol use and potential years of life lost (YLL) from major alcohol-related causes of death in US adults through 2030, by sex, race and ethnicity, and educational attainment as a proxy for socioeconomic status.

Design, Setting, and Participants: This was a decision analytical study that used a dynamic individual-level microsimulation model of nationally representative of US adults (age ≥18 years) from 2000 to 2030 and considered sociodemographic variables, alcohol use, and mortality risks.

Interventions: Four expansion scenarios increasing the annual number of eligible individuals receiving ASBI from 2025 to 2030: scenario 1, expanding alcohol screening (AS) only; scenario 2, expanding brief intervention (BI) by 4 million; scenario 3, expanding BI by 8 million; and scenario 4, universal ASBI delivery. Scenarios were compared with a no-expansion counterfactual assuming historical trends.

Main Outcomes and Measures: Prevalence of hazardous alcohol use (>20 or >40 g of alcohol per day for women and men) and YLL per 100 000 before age 75 years from 5 key alcohol-related causes of death (alcohol use disorder, liver disease and cirrhosis, motor vehicle injuries, other unintentional injuries, and suicide) in 2030.

Results: The analysis of the microsimulation model found that scenario 3 (additional 8 million BI) and scenario 4 (universal ASBI) had the strongest impact on alcohol use and mortality, and were projected to reduce annual alcohol-related YLL per 100 000 by −51.3 (95% credible interval [CrI], −73.2 to −32.8) and −68.9 (CrI, −102.2 to −44.8) among men, respectively, and −34.1 (CrI, −54.5 to −16.1) and −52.0 (CrI, −75.0 to −30.2) among women, respectively, by 2030. In scenario 4, the gap in YLL from causes associated with alcohol use between low and high education narrowed by −3.5% (−64.5 YLL per 100 000; 95% CrI, −106.3 to −35.9) among men and −4.9% (−31.4 YLL per 100 000; 95% CrI, −56.2 to −12.4) among women.

Conclusions and Relevance: In decision analytical model expanding ASBI delivery in primary care was projected to reduce premature mortality and may represent an important strategy for improving population health. Substantial expansion had measurable but modest potential to narrow socioeconomic inequalities in premature mortality from causes of death associated with alcohol use.