No effects of increased alcohol availability during adolescence on alcohol-related morbidity and mortality during four decades: a natural experiment

Emelie Thern, Ting Jia, Mikaela Willmer, Jeroen de Munter, Thor Norstrom, Mats Ramstedt, George Davey Smith, Pers Tynelius, Finn Rasmussen

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Abstract

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.
Original languageEnglish
Article numbere209164
Number of pages6
JournalJournal of Epidemiology and Community Health
Volume71
Issue number11
Early online date18 Sep 2017
DOIs
Publication statusPublished - Nov 2017

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