Acute Alcohol Use and Suicide

描述（由申请人提供）：本提案是BGES于2010年6月审核的R01 AA020063-01的修订。这些修订解决了方法上的缺点。这个项目仍然很重要，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，是第11大死亡原因，也是65岁之前潜在寿命损失年数的第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6,969人死亡，235,865人因酒精导致自杀。尽管对酒精使用障碍和自杀进行了深入研究，但对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，关于急性酒精使用的数据对于制定全面的自杀预防战略至关重要。在美国，对自杀者毒理学特征的研究一直受到小样本和有限地理覆盖的限制。该项目将利用来自国家暴力死亡报告系统（NVDRS）的最新数据来解决这些限制，NVDRS是一个大型（2003-08年有47,398名自杀死者）和人口统计学特征良好的数据库，其中包含毒理学信息（血液酒精浓度，BAC）以及与自杀有关的验尸官和法医报告。该项目的目的如下：(1)描述美国自杀者和按年龄、性别和种族划分的主要亚群体中血液酒精含量的流行病学情况；(2)比较自杀时BAC的存在和水平与匹配的一般人群对照组的BAC的估计存在和水平；(3)检查与不同自杀方式（如火器、上吊或吸毒）有关的血液酒精含量和水平；(4)与非酒精相关自杀相比，检验酒精控制政策对酒精相关自杀的影响。该项目还将调查自杀时饮酒和不饮酒人群的地理和时间差异。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疾病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用性指标、来自税务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长期趋势，估计涉及酒精的最常用自杀方法的风险，并评估酒精控制政策对酒精阳性自杀的影响，可弥补对酒精用于自杀的理解中的根本空白，从而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.