Economic Contraction and Alcohol-Related Suicides: A Multilevel Analysis

说明(申请人提供)：本建议书是BGE于2010年6月审阅的R01 AA021791-01的修订版。这些修订解决了方法上的缺陷。美国经济从2007年12月开始明显收缩。有大量证据表明，经济收缩，特别是失业水平，对自杀死亡风险的影响。但人们对酒精滥用在经济状况和自杀之间的复杂关系中扮演的角色知之甚少。初步数据显示，自经济衰退正式开始以来，男性自杀死者的急性中毒(血液酒精浓度为0.08g/dl)增加了至少10%。酒精在自杀中起着关键作用，实际上，2001-2005年因酒精自杀而死亡的人数为7235人，潜在寿命损失为242,456岁。该项目将使用国家暴力死亡报告系统(NVDRS)的最新数据来评估经济低迷对急性酒精中毒自杀率的影响。NVDRS是一个庞大的(2003-2009年57,813例自杀死亡)和人口特征良好的毒物学信息数据库(即BAC)。该项目的目标如下：(1)按地理区域和时间描述经济收缩之前(2003-07年)至经济收缩开始(2008-12年)之后(2008-12年)与急性酒精摄入有关的自杀事件；(2)按地理区域和时间检查经济困难的衡量标准和酒精相关自杀率之间的联系；(3)分析酒精消费和酒精供应在解释经济收缩和酒精相关自杀之间的联系(如果有的话)方面的作用；以及(4)比较不同年龄、性别、种族/民族和人口的社会经济亚群之间的经济收缩、酒精消费和酒精相关自杀之间的关系。多个级别的数据(州、州、县和个人)将被结合在一起，以捕捉经济低迷和与酒精相关的自杀人数变化之间的嵌套复杂性。该项目将利用多种经济困境指标，包括短期和长期失业率、家庭收入中位数、贫困率、房屋止赎率和房价中值。其他关键环境指标将包括人口饮酒模式、物质使用、精神健康状况和酒精控制政策(即酒精税、酒精销售点密度和酒精销售)。这些数据将来自劳工统计局、人口普查局、RealtyTrac、联邦住房金融局、国家酒精饮料控制协会、酒精政策信息系统、州酒精饮料控制委员会、酒精流行病学数据系统和全国药物使用与健康调查。记录经济收缩对与酒精相关的自杀死亡率的影响，对于州和联邦决策者来说将是相当有兴趣的，他们在应对预算赤字和长期低迷的同时，担心公共健康。

DESCRIPTION (provided by applicant): This proposal is a revision of R01 AA021791-01 that was reviewed in June 2010 by BGES. The revisions address methodological shortcomings. The United States economy contracted markedly starting December 2007. There is substantial evidence indicating the impact of contracting economies, particularly levels of unemployment, on suicide mortality risk. But less is known about the role alcohol misuse plays in the complex relationship between economic conditions and suicide. Preliminary data suggest that acute intoxication (blood alcohol concentration (BAC) e .08 g/dl) among male suicide decedents has increased at least 10% since the official start of the recession. Alcohol plays a key role in suicide and, indeed 7,235 deaths and 242,456 years of potential life lost resulted from alcohol-attributable suicides in 2001-05. This project will estimate the effect of the economic downturn on rates of suicide involving acute alcohol intoxication using newly available data from the National Violent Death Reporting System (NVDRS). The NVDRS is a large (57,813 suicide decedents in 2003-09) and demographically well-characterized database with toxicology information (i.e., BACs). The project aims are as follows: (1) describe suicides associated with acute alcohol ingestion by geographic region and by time from before (2003-07) to after the onset (2008-12) of the economic contraction; (2) examine the association between measures of economic distress and rates of alcohol-related suicide by geographic area and by time; (3) analyze the roles of alcohol consumption and alcohol availability in explaining connections (if any) between economic contraction and alcohol-related suicide; and (4) compare relationships among economic contraction, alcohol consumption, and alcohol-related suicide across age, gender, race/ethnicity, and socioeconomic sub-groups of the population. Several levels of data (state, substate, county, and individual) will be combined to capture the nested complexity between economic downturn and variation in alcohol-related suicides. The project will utilize multiple indicators of economic distress, including short- and long-term unemployment, median household income, poverty rates, home foreclosure rates, and median housing prices. Other key environmental indicators will include population drinking patterns, substance use, mental health status, and alcohol-control policies (i.e., alcohol taxes, density of alcohol outlets, and alcohol sales). These data will be obtained from the Bureau of Labor Statistics, Census Bureau, Realtytrac, Federal Housing Finance Agency, National Alcohol Beverage Control Association, Alcohol Policy Information System, state alcohol beverage control boards, Alcohol Epidemiological Data System, and the National Survey on Drug Use and Health. Documenting the effects of the economic contraction on alcohol- associated suicide mortality will be of considerable interest to state and federal decision-makers concerned about public health while dealing with budget deficits and a prolonged downturn.