A Systematic Review on the Effects of Alcohol Outlet Density on Alcohol-Related Harm in Urban Populations

Abstract

Introduction

Alcohol-related harm, including disease, violence, injury, and motor vehicle crashes, is a critical public health issue in urban settings. The density of alcohol outlets is increasingly recognised as a modifiable environmental factor that may contribute to harmful outcomes by increasing alcohol accessibility among urban populations. The objective of this review is to systematically evaluate the association between alcohol outlet density in urban environments and alcohol-related harms, such as violence, injury, mental health outcomes, and substance use disorders, among others.

Methods

A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, OVID, Cochrane, and Embase databases were searched, yielding 267 relevant articles written in English published between 2000 to present. Screening was then conducted on the Covidence platform using a PICO (Population, Intervention, Comparison, Outcome) framework inclusion-exclusion criteria. 30 studies were included for synthesis and data were extracted on population characteristics, alcohol outlet type (on-/off-premise), alcohol-related harm outcomes, statistical analyses and significance of associations. Risk of bias was assessed using the ROBINS-E tool.

Results 

Almost all studies (97%, n = 29) reported at least one positive association between increased alcohol outlet density and at least one form of alcohol-related harm. Among the most studied outcomes were violence or crime (n=13), injuries and accidents (n=6), and substance use disorder (n=5). Some studies found significant spatial or demographic modifiers, including age, gender, and neighbourhood deprivation. 

Conclusions

Alcohol outlet density is a significant contributor to a range of alcohol-related harms in urban populations. Both on- and off-premise outlets pose distinct health-related risks. These findings support the development of urban public health strategies that consider environmental alcohol access as a modifiable risk factor that needs to be addressed.