Effects of a large-scale alcohol ban on population-level alcohol intake, weight, blood pressure, blood glucose, and domestic violence in India: A quasi-experimental population-based study

Chakrabarti, Suman; Christopher, Anita; Scott, Samuel P.; Kishore, Avinash; and Nguyen, Phuong H. 2024. Effects of a large-scale alcohol ban on population-level alcohol intake, weight, blood pressure, blood glucose, and domestic violence in India: A quasi-experimental population-based study. Lancet Regional Health - Southeast Asia 26: 100427. https://doi.org/10.1016/j.lansea.2024.100427

Background Globally, alcohol consumption is a leading risk factor for deaths and disability and a causal factor in over 200 diseases, injuries, and health conditions. In April 2016, the manufacture, transport, sale, and consumption of alcohol was banned in Bihar, a populous Indian state. We sought to estimate the impacts of this ban on health outcomes and domestic violence.

Methods Data from the Indian National Family Health Surveys (2005–06, 2015–16, 2019–21), Annual Health Survey (2013), and District Level Household Survey (2012), were used to conduct difference-in-differences (DID) analysis, comparing Bihar (n = 10,733 men, n = 88,188 women) and neighbouring states (n = 38,674 men, n = 284,820 women) before and after the ban. Outcomes included frequent (daily or weekly) alcohol consumption, underweight, obesity, hypertension, diabetes, and intimate partner violence. A triple difference model adding male–female interaction to the DID model was also estimated. Attributable averted cases were calculated to estimate the impact of the ban.

Findings Across all models, the ban led to reduced frequent alcohol consumption (DID: −7.1 percentage points (pp) (95% CI −9.6pp, −4.6pp), lower overweight/obesity (−5.6pp (−8.9, −2.2) among males, and reduced experiences of emotional (−4.8pp (−8.2pp, −1.4pp) and sexual (−5.5pp (−8.7pp, −2.3pp) violence among females. The ban prevented approximately 2.4 million cases of daily/weekly alcohol consumption and 1.8 million cases of overweight/obesity among males, and 2.1 million cases of intimate partner violence among females.

Interpretation Strict alcohol regulation policies may yield significant population level health benefits for frequent drinkers and many victims of intimate partner violence.