Simulation of Alcohol Control Policies for Health Equity (SIMAH): Study design and first results

Since about 2010, life expectancy at birth in the United States (US) has stagnated and begun to decline with concurrent increases in the socioeconomic divide in life expectancy. The Simulation of Alcohol Control Policies for Health Equity (SIMAH) project uses a novel microsimulation approach to investigate the extent to which alcohol use, socioeconomic status (SES), and race/ethnicity contribute to unequal developments in US life expectancy and how alcohol control interventions could reduce such inequalities.

Representative, secondary data from several sources will be integrated into one coherent, dynamic microsimulation to model life course changes in SES and alcohol use and cause-specific mortality attributable to alcohol use by SES, race/ethnicity, age, and sex. Markov models will be used to inform transition intensities between levels of SES and drinking patterns. To investigate alcohol control intervention strategies, a baseline scenario will be contrasted with multiple counterfactual intervention scenarios.

Preliminary analyses on the demographic foundation of the microsimulation model, including aging, transitioning between levels of SES (educational attainment), migration, and cause-specific mortality, were performed. The preliminary results indicate that the crucial microsimulation component provides good fit to observed demographic changes in the population, providing a robust baseline model for further simulation work. The microsimulation showed (in accordance with observed data) that mortality rates for causes of death closely related to alcohol use (including alcohol use disorders, liver disease and cirrhosis, and suicide) increased between 2000 and 2018 for both sexes, with overall higher increases among individuals with low SES.

By demonstrating the feasibility of this novel approach, the SIMAH project promises to offer superior integration of relevant empirical evidence to investigate the dynamics between alcohol use, SES, race/ethnicity, and mortality in the US. Furthermore, the microsimulation will allow for dynamic modelling of diverse intervention scenarios to inform public health policy for a more equitable future.