The impact of eliminating alcohol taxes on violence in Hong Kong

Abstract

Background: Despite extensive research showing that taxation and pricing strategies reduce alcohol consumption and alcohol-related harm, the Hong Kong Government embarked on an alcohol tax reduction and elimination policy. The heavy exercise duty on beer and wine was first halved in 2007, and eliminated altogether in 2008. In contrast to most high-income economies, Hong Kong has no sales tax, production levies nor alcohol duties. We studied the impact of this natural experiment on health service admissions and attendances for violence. Methods: We obtained health care service data covering all publicly provided inpatient and outpatient services from 2006 to 2017 in Hong Kong from the Hospital Authority electronic health care records. Diagnoses were coded according to International Classification of Disease (9th revision). Incidence rates was age and sex standardized to the Hong Kong end-year population. Exact confidence intervals were calculated using a Poisson distribution. Results: The change in alcohol duty was associated with a 13.5% increase (95% CI: 2.3%, 26.0%) in admissions for assault among women from 20.8 per 100,000 person-years (95% CI: 19.3, 22.5) to 23.7 per 100,000 person-years (95% CI: 22.0, 25.4). No significant changes were observed in men (incidence rate ratio 0.95, 95% CI: 0.89, 1.02). Undetermined injuries increased by 27.0% in women (95% CI: 19.1%, 35.4%), and 18.1% in men (95% CI: 11.0%, 25.6%). Accidental falls increased by 12.2% in women (95% CI: 9.9%, 14.6%), and 6.8% in men (95% CI: 4.4%, 9.3%). Poisoning increased by 30.5% in women (95% CI: 22.1%, 39.6%), and 25.2% in men (95% CI: 17.1%, 34.0%). No statistically significant changes were observed for suicide and self-inflicted injuries. Conclusions: Increase in assaults and undetermined injuries disproportionately affected women compared to men among Chinese people in Hong Kong. Reassessment of the alcohol taxation policy in Hong Kong may be warranted.