Associations of minimum legal drinking age law with later-life alcohol use and alcohol-attributable mortality from disease and injury: An ecological study

PURPOSE: To examine associations of minimum legal drinking age (MLDA) laws with later-life alcohol use and alcohol-attributable mortality. METHODS: An ecological study was performed using the free-access data from the United States. Five outcome measures were considered: (1) drinking rate, (2) alcohol consumption per capita, and alcohol-attributable mortality for (3) all diseases and injuries, (4) non-injury diseases, and (5) injuries. Univariate statistical tests compared differences in 5 outcome measures during 1990-2021 across 3 types of states, classified based on different MLDA beer laws in 1970-1988. Multivariable regression examined MLDA laws' associations with 5 outcome variables, adjusting for covariates. Sensitivity analyses used MLDA classifications for wine and spirits. RESULTS: Based on MLDA beer laws of 1970-1988, the 50 states and the District of Columbia were classified as Type 1 (increasing MLDA), Type 2 (fluctuating MLDA), and Type 3 (steady MLDA of 21). For all years combined, Type 1 and Type 2 states had lower and higher drinking rates (51.05% and 55.20% vs. 53.23%) and alcohol consumption per capita (463.25 and 511.57 vs. 483.92 standard drinks). Compared to Type 2 and Type 3 states, Type 1 states had the highest alcohol-attributable injury mortality for Americans aged 30 years and older (4.30 vs. 3.93 and 3.87 per 100,000). After adjusting for the included covariates, 3 types of states demonstrated differing trends in drinking rate and alcohol-attributable injury mortality but highly similar trends in the other 3 outcome measures. Sensitivity analyses generated similar findings. CONCLUSIONS: MLDA was associated with later-life alcohol use and alcohol-attributable mortality.