Acute Alcohol Use and Suicide

说明(申请人提供)：本建议书是BGE于2010年6月审阅的R01 AA020063-01的修订版。这些修订解决了方法上的缺陷。该项目仍然具有重要意义，因为自杀是一个主要的国家公共卫生问题，每年约有3万人死亡，占总死因的第11位，也是65岁之前潜在寿命损失(YPLL)的第5大原因。酒精在自杀中起着关键作用，事实上，根据疾病控制和预防中心的数据，2001年有6969人死于酒精导致的自杀，235865人死于酒精导致的长寿。虽然酒精使用障碍和自杀已经被深入研究，但关于急性酒精使用和自杀(即在事件发生前饮酒)的研究相对较少。然而，关于急性饮酒的数据对于制定全面的自杀预防战略至关重要。在美国，自杀死者的毒理学特征研究一直受到样本少和地理覆盖范围有限的限制。该项目将利用国家暴力死亡报告系统(NVDRS)、一个大型数据库(2003-08年自杀死亡人数为47398人)和人口特征良好的毒物信息数据库(血液酒精浓度)以及与自杀有关的验尸官和法医报告提供的新数据来解决这些限制。该项目的目标如下：(1)描述美国自杀死者和按年龄、性别和种族定义的主要亚群中血液酒精含量的流行病学；(2)比较自杀时BAC的存在和水平与匹配的一般人群对照组中估计的BAC存在和水平；(3)检查与不同方法(例如，枪支、上吊或药物摄入)自杀有关的血液酒精含量存在和水平；以及(4)测试酒精控制政策对酒精相关自杀与非酒精相关自杀的影响。该项目还将研究自杀时饮酒和不饮酒的人之间的地理和时间差异。这项研究建立在一个多层次的框架上，在这个框架中，县被嵌套在州内。关键的环境预测指标将包括来自全国酒精及相关条件流行病学调查的人口饮酒模式数据，来自美国人口普查局商业和工业数据的酒精可获得性指标，来自税收基金会的酒精税率，以及来自行为风险因素监测系统的枪支获取指标。记录与酒精有关的自杀死亡率水平和随时间变化的趋势，估计与酒精有关的最常用自杀方式的风险，并评估酒精控制政策对酒精阳性自杀的影响，以解决对酒精在自杀中使用的理解方面的根本差距，并对酒精政策和自杀预防战略的协调产生影响。

DESCRIPTION (provided by applicant): This proposal is a revision of R01 AA020063-01 that was reviewed in June 2010 by BGES. The revisions address methodological shortcomings. The project remains significant because suicide is a major national public health problem with about 30,000 deaths each year, representing the 11th leading overall cause of death and the 5th leading cause of years of potential life lost (YPLL) before age 65. Alcohol plays a key role in suicide and, indeed, according to the Centers for Disease Control and Prevention, 6,969 deaths and 235,865 YPLL resulted from alcohol-attributable suicides in 2001. Although alcohol use disorders and suicide have been intensively studied, there is comparatively little research on acute alcohol use and suicide (i.e., drinking prior to the event). Yet, data on acute alcohol use is essential for developing a comprehensive suicide prevention strategy. Research on toxicological characteristics of suicide decedents in the United States has been constrained by small samples and limited geographic coverage. This project will address these limitations using newly available data from the National Violent Death Reporting System (NVDRS), a large (47,398 suicide decedents in 2003-08) and demographically well-characterized database with toxicology information (blood alcohol concentration, BAC) as well as coroner and medical examiner reports pertaining to suicides. The project aims are as follows: (1) describe the epidemiology of blood-alcohol content among suicide decedents in the United States and among major subgroups defined by age, gender, and ethnicity; (2) compare BAC presence and levels at time of suicide to estimated BAC presence and levels in a matched general population control group; (3) examine blood-alcohol content presence and levels in relation to suicide involving different methods (e.g., firearm, hanging, or drug ingestion); and (4) test the effects of alcohol control policies on alcohol-related suicides compared to non-alcohol-related suicides. The project will also examine geographic and temporal variation among those who were and those who were not using alcohol at the time of suicide. The research is built on a multi-level framework in which counties are nested within states. Key environmental predictors will include data on population drinking patterns from the National Epidemiologic Survey on Alcohol and Related Conditions, alcohol availability indicators from the US Census Bureau Business and Industry Data, alcohol tax rates from the Tax Foundation, and firearm access indicators from the Behavioral Risk Factor Surveillance System. Documenting the alcohol-associated suicide mortality levels and trends over time, estimating the risk for the most commonly used method of suicide with alcohol involvement, and evaluating the effects of alcohol control policies on alcohol-positive suicides address fundamental gaps in the understanding of alcohol use in suicide with implications for the harmonization of alcohol policy and suicide prevention strategies.