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

Abstract

BackgroundA 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.MethodsA 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.ResultsIn 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.ConclusionThe 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.

The association of lowered alcohol prices with birth outcomes and abortions: A population‐based natural experiment

“…In 1967–68, a regional policy experiment in Sweden made strong beer available to individuals aged 16 years or older, which increased access to alcohol among the youth. The policy change was directly associated with a higher rate of female births, which indicates fetal losses, while associations with later life health among those exposed in utero have been less consistent [6–8]. The only prior natural experiment study focusing on alcohol prices found that within‐state increases in alcohol taxes between 1985 and 2002 in the United States were associated with higher birth weights and Apgar scores [13].…”

“…The one prior study focusing on how alcohol prices affect birth outcomes failed to account for both temporal trends and other simultaneous policy changes [13]. Secondly, the evidence from outside the United States is limited to Sweden in the 1960s, and mainly focused upon later life outcomes, which are affected by factors beyond in‐utero exposure [6–8]. Thirdly, prior studies have not assessed birth outcomes and abortions simultaneously.…”

“…Evidence on whether and how changes in alcohol availability associate with birth outcomes is, however, scarce. Policy changes such as those affecting alcohol prices or legal drinking age provide an opportunity to assess how changes in availability affect birth outcomes in real-world settings where randomized controlled trials are not possible [4][5][6][7][8]. As opposed to clinical or survey studies marred by sampling and self-report bias, natural experiment studies relying upon a clearly defined change in alcohol availability and objective outcomes can help to provide reliable evidence on the population-level impact of such changes [1,[9][10][11].…”

“…Secondly, the evidence from outside the United States is limited to Sweden in the 1960s, and mainly focused upon later life outcomes, which are affected by factors beyond in-utero exposure [6][7][8]. Thirdly, prior studies have not assessed birth outcomes and abortions simultaneously.…”

Does early drug use‐related police contact predict premature mortality and morbidity: A population register‐based study

“…Also, administrative register data enables prospective designs without recall bias [ 10 ] and can bring new insights to the study of health consequences of early drug use onset, as it has done for the effects of early onset alcohol use. A Swedish longitudinal register‐based study [ 11 ] found there is no clear connection between the earlier onset of alcohol use and premature risk of death when compared to later onset, although studies based on cross‐sectional designs suggested such effects [ 12 ]. Further, Kendler and his colleagues [ 13 ] analysed the association between drug use and mortality based on nationwide register data showing a strong association between registry‐ascertained drug use and premature mortality from both non‐medical and medical causes.…”