Republic of the Philippines

BULACAN STATE UNIVERSITY

Guinhawa, City of Malolos, Bulacan College of Science

The Impact of Alcohol Use Disorders on Mortality Rates:

A Friedman's Test Approach

ANIAG, Justine Nicolette M.

CARPIO, Mikhaela G.
ESTRELLA, Erica Joy S.
GARCIA, Kristianne S.
SANTIAGO, Via Bianca D.
BSM AS – 3A

Mr. Joshua P. Valeroso

(Instructor)

March 31, 2023

 Introduction
Alcohol has been a part of human civilization for thousands of years, with its
consumption playing a prominent role in social and cultural events. Drinking
alcohol does not necessarily lead to an alcohol use disorder. However, with the rise citation?
of industrialization and mass production, alcohol became more accessible and
affordable, leading to increased consumption and addiction. According to Patel &
Mandal (2018), when an individual consumes alcohol, the substance interacts with Before you
introduce an
various neurotransmitters in the brain, including dopamine, serotonin, and GABA. acronym or
These interactions can produce pleasurable effects, such as relaxation, euphoria, abbreviation, state
the complete word
and decreased inhibitions. With repeated use, the brain begins to adapt to these first.
effects and can become less responsive to alcohol. This can lead to increased
alcohol consumption as an individual seeks to achieve the same pleasurable effects.
Over time, excessive alcohol consumption began to have serious health
consequences, leading to physical and psychological dependence on alcohol, which
can manifest as an alcohol use disorder. Alcohol use disorder is a chronic brain
disease that develops gradually over time, with repeated exposure to alcohol. These
disorders are prevalent worldwide, particularly in high-income and upper-middle-
income countries and can cause significant harm and mortality due to medical
complications such as liver cirrhosis or injury (Carvalho et al., 2019). Despite their
high prevalence, these disorders are often undertreated due to social stigma and
inadequate screening in primary health care.
1. Problem and its Background
The impact of drinking alcohol on mortality rates is a significant public health concern, as
excessive alcohol consumption has been linked to an increased risk of premature death. According
to the World Health Organization (2022), alcohol use is responsible for more than three million
deaths globally each year, accounting for 5.3% of all deaths. Excessive alcohol consumption can
lead to a range of health problems, including liver disease, cancer, and cardiovascular problems.
Chronic heavy drinking can also increase the risk of mental health problems such as depression,
anxiety, and suicide.
The impact of alcohol on mortality rates is influenced by various factors, including the
amount and pattern of alcohol consumption, age, gender, and overall health status. Heavy and
prolonged alcohol consumption can increase the risk of mortality, particularly for individuals with
pre-existing health conditions such as liver disease or cancer. However, it is important to note that
moderate alcohol consumption has been associated with certain health benefits, including a lower
risk of heart disease. The definition of moderate alcohol consumption varies depending on the
country, but generally refers to one to two drinks per day for men and one drink per day for women.
Understanding the trends of deaths from alcohol use disorders is critical for developing
effective prevention and treatment strategies, as well as for addressing the broader social and
economic impacts of alcohol use. This information can help policymakers, healthcare providers,
and researchers to identify populations at greatest risk, target interventions to prevent alcohol-
related deaths, and evaluate the effectiveness of interventions over time.
In this context, statistical methods such as the Friedman test can be used to analyze trends
in deaths from alcohol use disorders over time and across different countries. The Friedman test is
a non-parametric statistical test that can be used to compare the differences among three or more
related groups or treatments. By examining the changes in the number of deaths over time, this
method can help identify significant differences or patterns in the data, providing valuable insights
for researchers, policymakers, and healthcare providers.
This paper aims to provide an overview of the use of the Friedman test in analyzing trends
in deaths from alcohol use disorders. Specifically, researchers will examine how the Friedman test
can be used to compare the differences in the number of deaths across different countries within
time periods. By highlighting the strengths and limitations of this statistical method, researchers
aim to provide guidance for future researchers and practitioners who wish to apply the Friedman
test in their own research on alcohol use disorder.
1.1 Statement of the Problem
The general problem of this study entitled “The Impact of Alcohol Use Disorders on
Mortality Rates” was to test the effect of alcohol use disorders on mortality rates across different
countries in terms of successive years.
Specifically, it sought answer to the following question:
1. Does the distributions of the data on mortality rates from alcohol use disorders over the past
five years are randomly distributed?
2. Do alcohol use disorders have a significant impact on the mortality rates over the past five
years? Friedman's test is used for testing significant
differences among the groups. "Significant impact" is
1.2 Hypothesis used for other tests such as correlation and such
testing for relationships.
Since there are two questions to be answered at the end of this study, therefore there should
also be two sets of hypotheses.
: The data on mortality rates from alcohol use disorders over the past five years are not randomly
distributed.
: The data on mortality rates from alcohol use disorders over the past five years are randomly
distributed.
: Alcohol use disorders has no significant impact in the mortality rates over the past five years.
: Alcohol use disorders has a significant impact in the mortality rates over the past five years.
2. Methodology
This section of the study will discuss the various methods and statistical techniques that
will be employed to address the Statement of the Problem.
2.1 One-way ANOVA with Repeated Measures
The application of ANOVA with repeated measures is to compare mean values of three or
more groups having the same participants. This method is employed in two situations, one where
participants are measured repeatedly to observe changes due to an intervention and secondly,
where participants are exposed to multiple conditions/trials and the response to each condition is
to be compared.
One-way ANOVA with repeated measures is a parametric procedure, and it is necessary
to evaluate the deviation from its assumptions to ensure the quality of the results. Unlike original
data values, the assumptions of a dependent t-test are based on the differences between two sets of
values. The four significant assumptions of one-way ANOVA with repeated measures are as
follows:
a. The measure of the dependent variable should be at either the interval level or the
ratio level.
b. The independent variable should comprise a minimum of two groups that are
related and categorical.
c. There should be no significant outliers present in any of the related groups.
d. The distribution of the dependent variable in the two or more related groups should
be approximately normally distributed.
It is better to end a section with a paragraph.
2.2 The Violated Assumptions to the Parametric Tests
Since the normality assumption for data is not met, using parametric statistical tests may
increase the risk of committing a Type I error. To avoid this scenario, the researchers have decided
to employ the non-parametric equivalent of one-way ANOVA with repeated measures, which is
the Friedman Test. As this non-parametric test does not rely on any distributional assumptions, it
is a reliable alternative that can minimize the chances of errors while obtaining the test statistic.
2.3 Friedman’s Test
Friedman’s test is a statistical method that does not rely on a specific distributional
assumption, making it a non-parametric test used to detect differences in treatments across multiple
attempts. This test is employed in situations when the distribution of data is unknown, and it serves
as an alternative to the ANOVA test. Additionally, Friedman’s test is an extension of the sign test
that applies when there are multiple treatments involved, and it is identical to the two-sample sign
test when there are only two treatments. Two different versions of this test are available:
 ● Measuring the median scores of subjects across three or more time periods.
● Measuring the median scores of subjects under three different conditions.
Therefore, it is important to ensure that you are using the correct version of the test for your
specific needs and that you understand the parameters and assumptions underlying the test.
3. Results and Discussions
In this section, the researcher provides a clear and concise summary of the data,
highlighting the key results that are most relevant to the research question and hypothesis.
Additionally, the researcher analyzes the results and derives conclusions based on the findings.
3.1 Runs Test
To test the randomness of the data, the Runs test was conducted. The run test of randomness
is a statistical procedure utilized to assess the level of randomness in data. This test is also referred
to as the Geary test and is a nonparametric test. The assumptions before performing a runs test
have been verified. First, when conducting a run test to determine randomness, it is assumed that
the data has been arranged sequentially and not grouped. If the data is not in sequence, then it is
necessary to attribute the mean, median or mode value to the data. In this case, the researchers
exclusively employed the median since it is for non-parametric statistics when dealing with data
that is not normally distributed. Second, the data is presented in a numerical form. This assumption
is essential to perform the test because assigning runs to the numerical data can only be done if the
data is numeric. Lastly, the probability of a run in the run test of randomness is independent.

The results of the Runs test shows that p value for the year 2015 to 2019 are .278, .278,
.129, .129, and .129 respectively and all of these are greater than 0.05. Thus, we reject null
hypothesis and conclude that the data on mortality rates from alcohol use disorders over the past
five years are randomly distributed. This suggests that there may be a systematic trend or pattern
in the data that is not due to chance alone.
Is it random or not?
 The reason why
you conducted
Runs Test is to
prove that the
3.2 Friedman’s Test sample was
gathered
The assumptions before conducting a Friedman’s Test have been verified. First, one grouprandoml, then
you will say here
that is measured on three or more different occasions. In this case, researchers used the availablethat purposive
data regarding the mortality rates from alcohol use disorders on different countries which weresampling
conducted?
was

measured on the year 2015, 2016, 2017, 2018, and 2019 respectively. Second, a group is a random
sample from the population. Researchers use purposive sampling to select countries with high rates
of mortality rates on alcohol use disorders to specifically investigate those areas of interest. Third,
dependent variable should be measured at the ordinal or continuous level. In this case, the number
of deaths from alcohol use disorders represent a continuous scale with equal intervals between
values, but with no meaningful zero point. Lastly, samples do not need to be normally distributed.
Test Statisticsa

N 86
Chi-Square 209.320

df 4

Asymp. Sig. .000

a. Friedman Test

The Friedman’s test shows that χ^2(4) = 209.320, p < 0.05, 209.320 > .000 which means
that we reject null hypothesis and conclude that alcohol use disorders have a significant impact in
the mortality rates over the past five years. The results of this study indicate that mortality rates
for countries with cases of alcohol use disorder have significantly increased over the past five
years. Specifically, research’s findings reveal a significant increase in mortality rates in 2019,
which is consistent with other recent studies that have highlighted the growing concern of alcohol-
related deaths in the United States (National Institute on Alcohol Abuse and Alcoholism, 2020).
According to Rehm et al. (2019), there was a notable rise in death rates in 2019, which could be
explained by several reasons. One of the factors contributing to this increase was the growing trend
of binge drinking and excessive alcohol consumption, which has been linked to a higher
probability of health problems and accident.
Despite the significant increase in mortality rates in 2019, it is important to note that no
other significant differences were found across the five-year period. This suggests that mortality
rates for individuals with alcohol use disorder have remained relatively stable from 2015 to 2018.
However, it is important to continue monitoring these rates and implementing interventions to
address the growing concern of alcohol-related deaths.
 In this section, the researchers briefly restate the research question, followed by a summary
of the key results and conclusions drawn from the analysis. Furthermore, this section outlines
specific actions that can be taken to build upon the research results, address any limitations, and
advance the field.
4 Conclusions and Recommendations
In this section, the researchers briefly restate the research question, followed by a summary
of the key results and conclusions drawn from the analysis. Furthermore, this section outlines
specific actions that can be taken to build upon the research results, address any limitations, and
advance the field.
4.1Conclusions
The researchers used non-parametric tests to determine the influence of alcohol use
disorders on mortality rates. The use of Friedman’s Test resulted in finding that {χ^2(4) = 209.320,
p < 0.05, 209.320 > .000}, indicating a significant increase in mortality rates over the past five
years. Less number should be seen at the conclusion

However, to assess the level of randomness in the data, runs test was utilized. The results
indicated that the p value was all greater than 0.05. Therefore, it appears that the data on mortality
rates are randomly distributed.
The researchers advise performing another type of test to improve the test results.
Additionally, the researchers arrive at the following conclusions to enhance this study.
4.2 Recommendations
After a thorough analysis of data, the following recommendations are hereby made:
1. Further research should be conducted to address the limitations of this study. The study only
focused on the impact of alcohol use disorders on mortality rates across different countries in
terms of successive years, using the Friedman test as a statistical method to analyze the data.
However, there are other statistical techniques and methods that can be used to analyze the
same data, such as the chi-square test, t-test, or linear regression analysis, which could provide
different insights into the relationship between alcohol use disorders and mortality rates.
2. Consider exploring the impact of other factors on mortality rates, such as socioeconomic status,
race, ethnicity, and cultural factors. This could provide a more comprehensive understanding
of the complex interactions between alcohol use disorders and mortality rates, which could
inform the development of more effective prevention and treatment strategies.
3. Explore the impact of alcohol use disorders on other health outcomes, such as mental health,
social functioning, and quality of life to provide a more holistic understanding of the impact
of alcohol use disorders on individuals and communities, which could inform the development
of more comprehensive prevention and treatment strategies.
4. Researchers should also consider increasing the number of years covered in the study to
examine long-term trends in mortality rates from alcohol use disorders. This would provide
more insights into the impact of alcohol use disorders on mortality rates over time.
5 Resources
Carvalho, A., Heilig, M., Perez A, et.al (2019). Alcohol Use Disorders. Retrieved from:
https://pubmed.ncbi.nlm.nih.gov/31478502/
Laerd Statistics (2018). Friedman Test in SPSS Statistics. Retrieved from:
https://statistics.laerd.com/spss-tutorials/friedman-test-using-spss-statistics.php
Laerd Statistics (2018). ANOVA with Repeated Measures using SPSS Statistic. Retrieved from:
https://statistics.laerd.com/spss-tutorials/one-way-anova-repeated-measures-using-spss-
statistics.php
Patel, F., & Mandal, P. (2018). Effect of Alcohol on Brain Development. Retrieved from:
https://www.intechopen.com/chapters/59317
Statistics Solutions (2023). Runs Test of Randomness. Retrieved from:
https://www.statisticssolutions.com/runs-test-of-randomness/
World Health Organization (2022). Alcohol. Retrieved from: https://www.who.int/news-
room/fact-sheets/detail/alcohol
6. Appendix (Raw Computations)
Table 1. Raw Data

COUNTRY 2015 2016 2017 2018 2019

Algeria 103 104 106 109 111

Angola 182 188 196 204 211

Argentina 728 742 771 795 821

Armenia 65 66 67 68 69

Australia 553 568 575 583 590

Austria 519 525 524 517 517

Azerbaijan 208 209 213 220 225

Bangladesh 286 295 305 314 322

Belgium 530 529 529 525 525

 Bolivia 337 346 353 361 368

Brazil 8958 9002 9092 9422 9705

Bulgaria 95 98 99 100 101

Cambodia 121 124 127 130 133

Cameroon 169 172 176 182 187

Canada 1321 1326 1335 1349 1361

Chile 486 481 503 517 531

China 19893 19803 19627 19499 19459

Colombia 112 115 118 121 124

Costa Rica 76 79 81 82 84

Cuba 561 579 577 575 570

Democratic Republic of Congo 591 605 623 650 672

Denmark 794 803 807 812 817

Ecuador 318 319 323 336 349

Egypt 139 142 145 148 150

England 1313 1326 1342 1334 1337

Ethiopia 567 585 604 626 647

France 3664 3700 3731 3728 3748

Germany 6320 6410 6406 6393 6379

Guatemala 1502 1521 1596 1679 1769

Haiti 345 354 362 373 383

Honduras 350 360 370 379 389

Hungary 496 525 528 535 541

India 20753 21469 22048 22687 23261

Indonesia 617 626 636 646 653

 Iran 232 236 240 245 250

Iraq 51 52 54 55 57

Ireland 89 91 92 94 95

Israel 56 58 61 63 65

Italy 349 350 350 350 351

Japan 677 676 675 667 670

Kazakhstan 1599 1599 1525 1626 1701

Kenya 298 305 315 327 340

Kyrgyzstan 354 356 364 385 403

Madagascar 140 144 149 155 159

Malaysia 157 162 167 171 176

Mexico 4048 4061 4157 4374 4518

Mongolia 543 554 563 573 584

Morocco 105 107 108 109 111

Mozambique 242 245 250 254 258

Myanmar 382 383 385 387 388

Nepal 210 215 218 223 227

Netherlands 476 497 488 484 480

Nicaragua 358 380 374 379 387

Nigeria 1145 1164 1183 1199 1221

North Korea 371 374 377 381 384

Norway 231 228 227 235 241

Pakistan 1943 1999 2050 2090 2142

Paraguay 293 318 320 319 318

Peru 280 292 307 325 342

 Philippines 1032 1054 1071 1088 1105

Portugal 180 179 180 181 182

Puerto Rico 131 131 136 138 141

Saudi Arabia 85 90 94 99 104

Scotland 271 271 270 270 270

Somalia 125 129 134 139 143

South Africa 605 588 586 578 582

South Korea 924 933 955 974 997

Spain 409 409 419 423 429

Sri Lanka 346 362 374 384 398

Sweden 348 348 356 359 364

Switzerland 263 260 268 272 277

Syria 59 59 59 60 61

Taiwan 451 458 437 427 415

Tajikistan 135 126 134 141 147

Tanzania 307 315 327 339 350

Thailand 615 629 631 631 634

Turkey 220 231 235 238 240

Turkmenistan 153 162 168 174 180

Uganda 231 237 241 252 261

Ukraine 7349 7317 7473 7601 7716

Uzbekistan 120 124 137 147 156

Venezuela 156 165 170 175 188

Vietnam 897 928 955 979 1000

Yemen 68 71 74 79 82
 Zambia 116 120 126 132 137

Zimbabwe 48 49 50 51 53

Computations for Friedman’s Test

Table 2. Friedman’s Test Table
Ranks of Mortality Rates from Alcohol Use Disorders
Countries 2015 2016 2017 2018 2019
Algeria 1 2 3 4 5
Angola 1 2 3 4 5
Argentina 1 2 3 4 5
Armenia 1 2 3 4 5
Australia 1 2 3 4 5
Austria 3 5 4 1.5 1.5
Azerbaijan 1 2 3 4 5
Bangladesh 1 2 3 4 5
Belgium 5 3.5 3.5 1.5 1.5
Bolivia 1 2 3 4 5
Brazil 1 2 3 4 5
Bulgaria 1 2 3 4 5
Cambodia 1 2 3 4 5
Cameroon 1 2 3 4 5
Canada 1 2 3 4 5
Chile 2 1 3 4 5
China 5 4 3 2 1
Colombia 1 2 3 4 5
Costa Rica 1 2 3 4 5
Cuba 1 5 4 3 2
Democratic Republic of Congo 1 2 3 4 5
Denmark 1 2 3 4 5
Ecuador 1 2 3 4 5
Egypt 1 2 3 4 5
England 1 2 5 3 4
Ethiopia 1 2 3 4 5
France 1 2 4 3 5
Germany 1 5 4 3 2
Guatemala 1 2 3 4 5
Haiti 1 2 3 4 5
 Honduras 1 2 3 4 5
Hungary 1 2 3 4 5
India 1 2 3 4 5
Indonesia 1 2 3 4 5
Iran 1 2 3 4 5
Iraq 1 2 3 4 5
Ireland 1 2 3 4 5
Israel 1 2 3 4 5
Italy 1 3 3 3 5
Japan 5 4 3 1 2
Kazakhstan 2.5 2.5 1 4 5
Kenya 1 2 3 4 5
Kyrgyzstan 1 2 3 4 5
Madagascar 1 2 3 4 5
Malaysia 1 2 3 4 5
Mexico 1 2 3 4 5
Mongolia 1 2 3 4 5
Morocco 1 2 3 4 5
Mozambique 1 2 3 4 5
Myanmar 1 2 3 4 5
Nepal 1 2 3 4 5
Netherlands 1 5 4 3 2
Nicaragua 1 4 2 3 5
Nigeria 1 2 3 4 5
North Korea 1 2 3 4 5
Norway 3 2 1 4 5
Pakistan 1 2 3 4 5
Paraguay 1 2.5 5 4 2.5
Peru 1 2 3 4 5
Philippines 1 2 3 4 5
Portugal 2.5 1 2.5 4 5
Puerto Rico 1.5 1.5 3 4 5
Saudi Arabia 1 2 3 4 5
Scotland 4.5 4.5 2 2 2
Somalia 1 2 3 4 5
South Africa 5 4 3 1 2
South Korea 1 2 3 4 5
Spain 1.5 1.5 3 4 5
Sri Lanka 1 2 3 4 5
 Sweden 1.5 1.5 3 4 5
Switzerland 2 1 3 4 5
Syria 2 2 2 4 5
Taiwan 4 5 3 2 1
Tajikistan 3 1 2 4 5
Tanzania 1 2 3 4 5
Thailand 1 2 3.5 3.5 5
Turkey 1 2 3 4 5
Turkmenistan 1 2 3 4 5
Uganda 1 2 3 4 5
Ukraine 2 1 3 4 5
Uzbekistan 1 2 3 4 5
Venezuela 1 2 3 4 5
Vietnam 1 2 3 4 5
Yemen 1 2 3 4 5
Zambia 1 2 3 4 5
Zimbabwe 1 2 3 4 5
Sum of Ranks 123 194.5 259.5 319.5 393.5
Sum of Ranks Squared 15129 37830.25 67340.25 102080.25 154842.25