Fatal Traumatic Brain Injuries During 13 Years of Successive Alcohol Tax Increases in Finland - A Nationwide Population-Based Registry Study

Background: Up to half of the patients who sustain traumatic brain injury (TBI) are intoxicated with ethanol at the time of injury. We sough to investigate how increases in alcohol taxation and changes in alcohol consumption were associated with the incidence of fatal traumatic brain injuries (TBIs) in Finland during the years 2004-2016. Methods: The nationwide, mandatory cause-of-death database covering all deaths of subjects 16 years of age in Finland was searched for deaths related to TBIs (ICD-10: S06·X) during 2004-2016. Data for alcohol consumption were obtained from the National Institute for Health and Welfare and for alcohol taxation from the Ministry of Finance. Occurrence rates were standardized to the Euro 2013 standard population. Findings: There were 28,657,870 person-years and 325,514 deaths of which 12,110 were TBI-related. The standardized incidence of TBI-related deaths was 22·0 (95% CI 21.61-22.38) per 100,000 person-years. Overall alcohol consumption decreased, on average, by 1.2% annually. Concurrently, the overall incidence of fatal TBIs decreased by 4·1% annually. There was an association between overall alcohol consumption and TBI-related mortality rate (p<0·001). Tax-rate increases of all beverage types were associated with a decreased incidence of TBI-related deaths in males (p<0·001), females (p<0·036), and overall (p<0·001). Interpretation: In this population-based study, we report that during 13 years of successive alcohol tax increases, overall alcohol consumption has decreased in parallel with a reduction in the incidence of fatal TBIs in Finland. Funding Statement: This work was partially funded by special government transfer tied to academic research in Health Sciences (JPP), a grant from the Finnish Brain Foundation sr (JPP), and a grant from the Emil Aaltonen Foundation sr (JPP). Declaration of Interests: Jussi P. Posti has received speaker’s fees from the Orion corporation and the Finnish Medical Association and a travel grant from Stryker; Matti Sankinen has received travel grants and congress fee coverage (Zimmer-Biomet, Baxter, Medtronic, Stryker, Aesculap/B. Braun, DePuy Synthes, Skulle Implants, Innosurge); Jussi O.T. Sipila has received honoraria (Pfizer, Merck), a consultancy fee (Norio centre), travel grants and congress fee coverage (Orion Corporation, Abbvie, Lundbeck, Merck Serono, Nordicinfucare, Sanquin) and holds shares (Orion Corporation); Jori O. Ruuskanen has received speaker fees (Sanofi-Aventis, Orion Pharma, Biogen Idec, UCB Pharma, Novartis, Roche, Merck, Genzyme, Bayer, TEVA), travel grants and congress fee coverage (Baxter, Bayer, GSK, Merck Serono, Boehringer Ingelheim, UCB Pharma, Lundbeck, Biogen Idec, Roche), and a consultancy fee (Merck); Jaakko Rinne has no financial disclosures; Paivi Rautava has received a travel grant (Roche and Merck); Ville Kyto has no financial disclosures. Ethics Approval Statement: The study was approved by the National Institute for Health and Welfare, Finland (permission no. THL/1484/5·05·00/2017) and Statistics Finland, Finland (TK53-1410-15). This is a retrospective registry study and no approval from an ethics committee was required.