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Introduction Stronger alcohol policies predict decreased alcohol consumption and binge drinking in the United States. We examined the relation- ship between the strength of states’ alcohol policies and alcoholic cirrhosis mortality rates.

Methods We used the Alcohol Policy Scale (APS), a validated assessment of policies of the 50 US states and Washington DC, to quantify the efficacy and implementation of 29 policies. State APS scores (the- oretical range, 0–100) for each year from 1999 through 2008 were compared with age-adjusted alcoholic cirrhosis death rates that oc- curred 3 years later. We used Poisson regression accounting for state-level clustering and adjusting for race/ethnicity, college edu- cation, insurance status, household income, religiosity, policing rates, and urbanization.

Results Age-adjusted alcoholic cirrhosis mortality rates varied signific- antly across states; they were highest among males, among resid- ents in states in the West census region, and in states with a high proportion of American Indians/Alaska Natives (AI/ANs). Higher APS scores were associated with lower mortality rates among fe- males (adjusted incidence rate ratio [IRR], 0.91 per 10-point in- crease in APS score; 95% confidence interval [95% CI], 0.84–0.99) but not among males (adjusted IRR, 0.97; 95% CI, 0.90–1.04). Among non-AI/AN decedents, higher APS scores were also associated with lower alcoholic cirrhosis mortality rates among both sexes combined (adjusted IRR, 0.89; 95% CI, 0.82–0.97). Policies were more strongly associated with lower mortality rates among those living in the Northeast and West census regions than in other regions.

Conclusions Stronger alcohol policy environments are associated with lower al- coholic cirrhosis mortality rates. Future studies should identify un- derlying reasons for racial/ethnic and regional differences in this relationship.


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Prev Chronic Dis, 12 E177. doi:

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