RT Journal Article
SR Electronic
T1 No effects of increased alcohol availability during adolescence on alcohol-related morbidity and mortality during four decades: a natural experiment
JF Journal of Epidemiology and Community Health
JO J Epidemiol Community Health
FD BMJ Publishing Group Ltd
SP 1072
OP 1077
DO 10.1136/jech-2017-209164
VO 71
IS 11
A1 Emelie Thern
A1 Ting Jia
A1 Mikaela Willmer
A1 Jeroen de Munter
A1 Thor Norström
A1 Mats Ramstedt
A1 George Davey Smith
A1 Per Tynelius
A1 Finn Rasmussen
YR 2017
UL http://jech.bmj.com/content/71/11/1072.abstract
AB Background A strict high legal age limit for alcohol purchases decreases adolescents’ access to alcohol, but little is known about long-term health effects. The aim was to estimate the effect of increased alcohol availability during adolescence on alcohol-related morbidity and mortality.Methods A nationwide register-based study using data from a natural experiment setting. In two regions of Sweden, strong beer (4.5%–5.6% alcohol by volume) became temporarily available for purchase in grocery stores for individuals 16 years or older (instead of 21) in 1967/1968. The intervention group was defined as all individuals living in the intervention area when they were 14–20 years old (n=72 110). The remaining Swedish counties excluding bordering counties, without the policy change, were used as the control group (n=456 224). The outcomes of alcohol-related morbidity and mortality were collected from the Hospital Discharge Register and Cause of Death Register, in which average follow-up times were 38 years and 41 years, respectively. HRs with 95% CIs were obtained by Cox regression analysis.Results In the fully adjusted model, no clear evidence of an association between increased alcohol availability during adolescence and alcohol-related morbidity (HR: 0.99, 95% CI 0.96 to 1.02) or mortality (HR: 1.02, 95% CI 0.95 to 1.10) was found.Conclusion The initial elevated risk of alcohol-related morbidity and mortality later in life among adolescents exposed to increased access to strong beer in Sweden vanished when a regional measure population density of locality was included in the model, which is important to consider in future research.