Background and Aims
This study estimates the association between per capita alcohol retail outlet density and blood alcohol concentration (BAC) from 51,547 suicide decedents. It also analyzes the relationship between alcohol outlet density and socio-demographic characteristics among alcohol positive suicide decedents in the United States by racial/ethnic groups and method of suicide.
Design
Analysis of U.S. data, 2003–11, National Violent Death Reporting System
Setting
Suicide decedents from 14 U.S. States
Cases
A total of 51,547 suicide decedents tested for blood alcohol content.
Measurements
Blood alcohol content and levels were derived from coroner/medical examiner reports. Densities of county level on-premise and off-premise alcohol retail outlets were calculated using the 2010 Census.
Findings
Multilevel logistic regression models suggested that higher off-premise alcohol outlet densities were associated with greater proportions of alcohol-related suicides among men -- for suicides with alcohol present (BAC>0; adjusted odds ratio [AOR]= 1.08, 95% confidence interval [CI]= 1.03–1.13). Interactions between outlet density and decedents’ characteristics were also tested. There was an interaction between off-premise alcohol availability and American Indian/Alaska Native race (AOR=1.36; 95% CI=1.10–1,69) such that this sub-group had highest BAC positivity. On-premise density was also associated with BAC > 0 (AOR=1.05; 95% CI=1.03–1.11) and BAC≥ 0.08 (AOR=1.05; 95% CI=1.02–1.09) among male decedents.
Conclusions
County-level on- and off-premise density are associated with alcohol-related suicide, especially among American Indians/Alaska Natives.