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Between Bar and Home

Margaret M. Gallaher, MD; David W. Fleming, MD; Lawrence R. Berger, MD, MPH; C. Mack Sewell, DrPH

JAMA. 1992;267(10):1345-1348.

Abstract
Objective.
—To determine the nature of excess injury mortality among Native Americans in New Mexico.

Design.
—Retrospective review of death certificates for deaths from unintentional injuries.

Setting.
—The state of New Mexico.

Subjects.
—New Mexico residents who died of unintentional injuries between January 1, 1980, and December 31, 1989.

Main Outcome Measure.
—Cause-specific mortality rates.

Results.
—Over half of the excess mortality from all unintentional injuries among Native Americans resulted from hypothermia and from pedestrian—motor vehicle crashes. New Mexico Native Americans were nearly eight times more likely to die in pedestrian—motor vehicle crashes and were 30 times more likely to die of hypothermia compared with other New Mexico residents. At death, 90% of those Native Americans tested were highly intoxicated (median blood alcohol concentrations of 0.24 and 0.18 mg/dL for pedestrian and hypothermia deaths, respectively). Despite the fact that most Native Americans in New Mexico live on reservations, most deaths occurred at off-reservation sites in border towns and on roads leading back to the reservation.

Conclusions.
—The possession and sale of alcohol is illegal on many Native American reservations. This policy forces Native Americans who want to drink to travel long distances to obtain alcohol. These data suggest that this policy is also the likely explanation for the markedly increased risk of death from hypothermia and pedestrian—motor vehicle crashes in this population.

(JAMA. 1992;267:1345-1348)

Author Affiliations
From the Office of Epidemiology, New Mexico Department of Health, Santa Fe (Drs Gallaher and Sewell); the Division of Field Services, Epidemiology Program Office, Centers for Disease Control, Atlanta, Ga (Dr Fleming); and the Lovelace Medical Foundation, Albuquerque, NM (Dr Berger). Dr Fleming is now with the Oregon Health Division, Portland.

Footnotes
Reprint requests to Office of Epidemiology, New Mexico Department of Health, PO Box 26110, 1190 St Francis Dr, Santa Fe, NM 87502 (Dr Gallaher).

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