Lower Alcohol Taxes Are Associated with Increased Liver Transplant Listing
1Medicine
Division of Gastroenterology and Hepatology, New York Presbyterian Hospital - Weill Cornell, New York, NY, 2Economics, University of North Carolina at Greensboro, Greensboro, NC, Greensboro, NC, 3Healthcare Policy and Research, Weill Cornell Medicine, New York, NY
Meeting: 2019 American Transplant Congress
Abstract number: D231
Keywords: Economics, Liver, Liver transplantation, Public policy
Session Information
Session Name: Poster Session D: Non-Organ Specific: Public Policy & Allocation
Session Type: Poster Session
Date: Tuesday, June 4, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Alcoholic liver disease (ALD) is a leading indication for liver transplantation worldwide with rising prevalence. Whether relationships exist between transplant listing for ALD and changes in state alcohol tax rates or alcohol consumption has not been explored.
*Methods: State-level alcohol per capita consumption of spirit, wine, and beer was determined from published United States 2003-2015 data. Excise and ad valorem on- and off-premise tax rates of spirit, wine, and beer were calculated following standard practices. Using the United Network for Organ Sharing (UNOS) database, we analyzed 2003-2015 state-wide patient-level data to determine if transplant listing for ALD was associated directly with alcohol consumption per capita and inversely with alcohol taxes. Univariate and multivariate regression was performed with clustering at the state level controlling for the pre-specified variables age, sex, race, education, employment, and insurance.
*Results: Of 137,440 patients listed for liver transplant, 21.2% (29,161) were for ALD, with increasing prevalence over time, up to 25.0% in 2015. Compared to all other patients, patients listed for ALD were more likely to be older, men, of White, Hispanic, or American Indian/Alaska Native race/ethnicity, unemployed, and with less education and private insurance (p < .01). Multivariate analysis indicated increased listing for ALD was associated with increased consumption of spirit (OR 1.67, 95% CI 1.12-2.49, p = .01); for each additional gallon of ethanol per capita of spirit consumed, patients were more likely to be listed for liver transplant for ALD. Multivariate analysis including consumption and taxation controlling for pre-specified variables did not significantly affect consumption findings and suggested a significant inverse relationship of spirit excise tax on-premise (OR .85, 95% CI .72-1.00, p = .05) and off-premise (OR .85, 95% CI .72-.99, p = .04) (Table 1); i.e. as spirit excise tax decreased, listing for ALD increased.
*Conclusions: Listing for liver transplantation for ALD was directly associated with alcohol per capita consumption and inversely associated with spirit excise taxes. These findings suggest a possible public health benefit of increasing spirit taxes.
| On-premise OR | On-premise 95% CI | On-premise p value | Off-premise OR | Off-premise 95% CI | Off-premise p value | ||
| Spirit consumption | 1.73 | 1.14-2.62 | .01 | 1.71 | 1.11-2.64 | .02 | |
| Spirit excise tax | .85 | .72-1.00 | .05 | .85 | .72-.99 | .04 | |
| Wine consumption | 1.52 | .96-2.41 | .08 | 1.50 | .99-2.27 | .06 | |
| Wine excise tax | .43 | .11-1.64 | .22 | .44 | .13-1.42 | .17 | |
| Beer consumption | 1.29 | .79-2.11 | .30 | 1.27 | .80-2.03 | .32 | |
| Beer excise tax | .04 | .00-1.44 | .08 | .04 | .00-1.44 | .08 |
To cite this abstract in AMA style:
Shen NT, Raver M, Hutchison N, Jesudian A, Bray J, Schackman B, Brown RS. Lower Alcohol Taxes Are Associated with Increased Liver Transplant Listing [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/lower-alcohol-taxes-are-associated-with-increased-liver-transplant-listing/. Accessed May 9, 2025.« Back to 2019 American Transplant Congress