The impact of alcohol pricing policies on public health in Hong Kong, China: a modelling study

Abstract

Objectives: Hong Kong reduced and eliminated taxes on beer, wine, cider, and ready-to-drinks over the last 15 years, leading to increasing alcohol consumption. We estimate the impact of reverting ad valorem taxes to pre-2008 tax levels (20% on wine and 40% on beer) on alcohol consumption and health outcomes in Hong Kong. Methods: We applied an econometric epidemiological modelling approach. We conducted econometric analyses using 15 years of industry sales and pricing data (2004-2018) to derive elasticity estimates. Using baseline alcohol consumption data (2018) in Hong Kong, we then applied risk functions from the World Health Organization (WHO) 2018 Global Status Report on Alcohol and Health to assess the impact on morbidity and mortality of wholly alcohol-attributable conditions and alcohol-attributable cancers. Results: The reintroduction of taxes to pre-2008 levels reduced alcohol consumption by 36.1%. The burden of alcohol related disease decreased with the largest decrease in wholly alcohol-attributable morbidity. We estimate a 34.5% overall reduction in the alcohol-attributable cancer mortality and morbidity with the largest relative decreases for cancers of the upper aerodigestive tracts, colorectum and breast. Discussion: Reversing the 2008 alcohol tax reductions is effective at averting wholly alcohol-attributable conditions and cancers. Our estimates are conservative as the high prevalence of the inactive aldehyde dehydrogenase-2 (ALDH2*2) genotype among East Asian populations, associated with increased alcohol toxicity, were not accounted for in the uniform alcohol-dose risk estimates adopted by the WHO. Reintroduction of taxes on alcohol can mitigate against avoidable harms of alcohol-related conditions.