Acute alcohol use among suicide decedents in 14 US states: Impacts of off-premise and on-premise alcohol outlet density

Norman Giesbrecht, Nathalie Huguet, Lauren Ogden, Mark S. Kaplan, Bentson H. Mcfarland, Raul Caetano, Kenneth R. Conner, Kurt B. Nolte

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Aims: To estimate the association between per capita alcohol retail outlet density and blood alcohol concentration (BAC) from 51547 suicide decedents and to analyse the relationship between alcohol outlet density and socio-demographic characteristics among alcohol-positive suicide decedents in the United States by racial/ethnic groups and method of suicide. Design: Analysis of US data, 2003-11, National Violent Death Reporting System. Setting: Suicide decedents from 14 US states. Participants: A total of 51347 suicide decedents tested for BAC. Measurements: BAC and levels were derived from coroner/medical examiner reports. Densities of county level on-premises and off-premises alcohol retail outlets were calculated using the 2010 Census. Findings: Multi-level logistic regression models suggested that higher off-premises alcohol outlet densities were associated with greater proportions of alcohol-related suicides among men-for suicides with alcohol present [BAC >0; adjusted odds ratio (AOR)=1.08, 95% confidence interval (CI)=1.03-1.13]. Interactions between outlet density and decedents' characteristics were also tested. There was an interaction between off-premises alcohol availability and American Indian/Alaska Native race (AOR=1.36; 95% CI=1.10-1.69) such that this subgroup had highest BAC positivity. On-premises density was also associated with BAC >0 (AOR=1.07; 95% CI=1.03-1.11) and BAC ≥0.08 (AOR=1.05; 95% CI=1.02-1.09) among male decedents. Conclusions: In the United States, the density of both on- and off-premises alcohol outlets in a county is associated positively with alcohol-related suicide, especially among American Indians/Alaska Natives.

Original languageEnglish (US)
Pages (from-to)300-307
Number of pages8
Issue number2
StatePublished - Feb 1 2015
Externally publishedYes


  • Acute alcohol use
  • Alcohol outlet density
  • Epidemiology
  • Race/ethnicity
  • Suicide
  • US states

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health


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