美国联邦法定最低饮酒年龄法对涉酒精枪支自杀的影响：一种断点回归方法。

The impact of the U.S federal minimum legal drinking age law on alcohol involved firearm suicide: a regression discontinuity approach.

作者信息

Jain Vageesh, Miller Matthew, Hemenway David

机构信息

Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA.

Northeastern University, Boston, MA, USA.

出版信息

EClinicalMedicine. 2025 Jan 10;80:103057. doi: 10.1016/j.eclinm.2024.103057. eCollection 2025 Feb.

DOI:10.1016/j.eclinm.2024.103057

PMID:39877261

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11773202/

Abstract

BACKGROUND

Suicide is a leading cause of death for young people. Half of young adult suicides are by firearm, and many involve alcohol consumption. We aimed to assess the impact of the minimum legal drinking age (MLDA) of 21 years on rates of alcohol positive firearm and non-firearm suicide.

METHODS

We used a regression discontinuity approach with data from the National Violent Death Reporting System (NVDRS) 2005-2021, among U.S suicide decedents in 14 states aged 16-35 years. The primary outcomes were the change in the proportion of tests positive for alcohol and the change in rates of alcohol positive suicide per 100,000 population at the MLDA.

FINDINGS

Across 14 states and 169 state-years, there were 434 alcohol positive suicides at age 20 and 684 alcohol positive suicides at age 21. The percentage of suicides with a positive alcohol test increased from 29.5% at age 20 to 38.7% at age 21 (p < 0.001), with a larger increase among firearm suicides relative to non-firearm suicides. Accounting for age-related trends, the total alcohol positive suicide rate increased by 1.52 per 100,000 (p < 0.001) at the MLDA, mostly due to an increase in alcohol positive firearm suicide. Compared to the expected rate in the absence of the MLDA, there was a 47.5% (95% CI 24.1%-81.8%) excess in firearm suicides, equivalent to 137 (95% CI 82-191) excess deaths. There was no discontinuity in the rate of alcohol negative firearm suicides at age 21. Blood alcohol content was not affected by the MLDA but was higher for firearm suicides across all ages.

INTERPRETATION

There was a large increase in the rate of alcohol positive suicide at the minimum legal drinking age (MLDA), driven by firearm suicide. Policies and programmes should aim to weaken the link between alcohol and firearms among those at or just above legal drinking age to prevent suicide.

FUNDING

The Commonwealth Fund and The Joyce Foundation.

摘要

背景

自杀是年轻人死亡的主要原因。年轻成年人自杀案例中有一半是使用枪支，且许多案例涉及饮酒。我们旨在评估21岁的最低合法饮酒年龄（MLDA）对酒精检测呈阳性的枪支自杀和非枪支自杀率的影响。

方法

我们采用回归断点法，使用2005 - 2021年国家暴力死亡报告系统（NVDRS）的数据，研究对象为美国14个州年龄在16 - 35岁的自杀死亡者。主要结局指标为酒精检测呈阳性的比例变化以及最低合法饮酒年龄时每10万人口中酒精检测呈阳性的自杀率变化。

研究结果

在14个州和169个州年期间，20岁时有434例酒精检测呈阳性的自杀案例，21岁时有684例。酒精检测呈阳性的自杀案例比例从20岁时的29.5%增至21岁时的38.7%（p < 0.001），枪支自杀案例的增幅相对于非枪支自杀案例更大。考虑到与年龄相关的趋势，在最低合法饮酒年龄时，每10万人口中酒精检测呈阳性的自杀总率增加了1.52（p < 0.001），主要是由于酒精检测呈阳性的枪支自杀案例增加。与不存在最低合法饮酒年龄时的预期率相比，枪支自杀案例多出47.5%（95%置信区间24.1% - 81.8%），相当于多出137例（95%置信区间82 - 191）死亡案例。21岁时酒精检测呈阴性的枪支自杀率没有断点。血液酒精含量不受最低合法饮酒年龄的影响，但在所有年龄段中，枪支自杀案例的血液酒精含量更高。