Alcohol-related injury death and alcohol availability in remote Alaska
M. G. Landen, M. Beller, E. Funk, M. Propst, J. Middaugh and R. L. Moolenaar
Division of Field Epidemiology, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Ga, USA.
CONTEXT: Injury is a major public health problem in Alaska, and alcohol
consumption and injury death are associated. OBJECTIVE: To determine the
association between injury death, particularly alcohol-related injury
death, and alcohol availability in remote Alaska. DESIGN, SETTING, AND
PARTICIPANTS: Survey using death certificate data and medical examiner
records to compare mortality rates for total injury and alcohol-related
injury during 1990 through 1993 among Alaskans aged 15 years and older who
had resided in remote villages of fewer than 1000 persons. MAIN OUTCOME
MEASURES: Rate ratios of injury death among residents of wet villages (ie,
those without a restrictive alcohol law) as compared with injury death
among residents of dry villages (ie, those with laws that prohibited the
sale and importation of alcohol). RESULTS: Of 302 injury deaths, blood
alcohol concentrations (BACs) were available for 200 deaths (66.2%). Of
these, 130 (65.0%) had a BAC greater than or equal to 17 mmol/L (> or
=80 mg/dL) and were, therefore, classified as alcohol related. The total
injury mortality rate was greater among Alaska Natives from wet villages
(rate ratio [RR],1.6; 95% confidence interval [CI], 1.3-2.1), whereas this
difference was not present for nonnatives (RR, 1.1; 95% CI, 0.3-3.8). For
Alaska Natives, the alcohol-related injury mortality rate was greater among
residents of wet villages (RR, 2.7; 95% CI, 1.9-3.8) than among residents
of dry villages. The strength of this association was greatest for deaths
due to motor vehicle injury, homicide, and hypothermia. CONCLUSIONS:
Although insufficient data existed to adjust for the effects of all
potential confounders, residence in a wet village was associated with
alcohol-related injury death among Alaska Native residents of remote Alaska
villages. These findings indicate that measures limiting access to
alcoholic beverages in this region may decrease alcohol-related injury
deaths.
