Alcohol policy and alcohol‐attributable disease burden in Eastern European Union countries, 1995 to 2023

AIMS: This study aimed to evaluate the restrictiveness of formal alcohol policies in eight Eastern European Union countries from 1995 to 2023 using a quantitative alcohol policy score and to analyse how variations in policy restrictiveness were associated with changes in total adult per capita alcohol consumption (APC) and alcohol-attributable disease burden. DESIGN: Longitudinal observational study based on cross-national comparisons over a 29-year period (1995-2023). SETTING: Bulgaria, Croatia, Czechia, Hungary, Poland, Romania, Slovakia and Slovenia. PARTICIPANTS/CASES: The units of the analyses were countries (n = 8) and years (n = 29). MEASUREMENTS: Annual data on statutory alcohol regulations were collected from national legal documents and scored using a modified Bridging the Gap (BtG-M) scale, where higher scores indicate more restrictive alcohol policies. Total APC data, a sum of recorded and unrecorded minus tourist consumption, were obtained from the World Health Organization. Alcohol-attributable disease burden was measured as age-standardized rates of years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs) and deaths per 100 000 population attributable to high alcohol use, based on estimates from the 2023 Global Burden of Disease Study (GBD). RESULTS: All countries displayed relatively low levels of formal policy restrictiveness, with BtG-M scores concentrated in the lower half of the scale. At the start of the study, Poland, Slovakia and Czechia showed the highest restrictiveness, while Croatia and Slovenia the lowest. By 2023, BtG-M scores converged upwards, with Poland and Slovenia recording the highest and Bulgaria and Croatia the lowest restrictiveness levels. Linear mixed-effects models indicated inverse association between policy restrictiveness and alcohol-attributable disease burden, particularly mortality; however, the associations were complex: BtG-M scores were negatively correlated with alcohol consumption and disease burden estimates in Croatia, Czechia, Romania and Slovenia, but not in the other four countries. SUMMARY: This study presents the first comprehensive longitudinal analysis of the relationship between formal alcohol policy restrictiveness and alcohol-attributable disease burden across eight Eastern European Union countries from 1995 to 2023. We found a complex relationship: in countries that strengthened alcohol policies (Croatia, Czechia, Romania and Slovenia), greater policy restrictiveness was associated with lower alcohol consumption and related harm. In the remaining countries (Bulgaria, Hungary, Poland and Slovakia), this relationship was not clearly observed, regardless of overall restrictiveness levels.