1. Northern Medical Program, University of Northern British Columbia, 3333 University Way, Prince George, British Columbia, V2N 4Z9, Canada; 2. Social and Epidemiological Research (SER) Department, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, ON M5S 2S1, Canada; 3. Dalla Lana School of Public Health, University of Toronto, 155 College St., Health Science Building, Toronto, Ontario, M5T 3M7, Canada; 4. Department of Biological Sciences, University of Toronto (Scarborough Campus), 1265 Military Trail, Toronto, Ontario, M1C 1A4, Canada
Background. Alcohol use is the largest contributor to the global burden of morbidity and mortality among adolescents and young adults aged 10-24 years old. As a result, countries worldwide have implemented minimum legal drinking age (MLDA) legislation, which is widely considered as the cornerstone of alcohol-control policies designed to reduce harms among young people. Recently, the Canadian Public Health Association and a national alcohol-policy coalition have recommended an increase in the MLDA in Canada. Currently, the MLDA is 18 years of age in Alberta, Manitoba, and Québec, and 19 years of age in the rest of the country. Few up-to-date studies, however, have assessed the influence of Canadian MLDA legislation on key population-based mortality or morbidity outcomes. The current line of research aims to estimate the impacts of Canadian drinking-age legislation on: inpatient and Emergency Department admissions, mortality, and motor vehicle collisions (MVCs). Our guiding hypothesis was: individuals just older than the MLDA would have significant increases in mortality and morbidity outcomes in comparison to their counterparts slightly younger than the MLDA.
Method and materials. We have conducted four studies, so far, using the following population-based data sets: nationwide inpatient hospitalization data from 1997-2006; Ontario inpatient and Emergency Department data from 2002-2007; mortality statistics from 1980-2008 from Statistics Canada; and MVCs from the Société de l'assurance automobile du Québec (SAAQ) from 2000-2012. We used a novel statistical technique—regression-discontinuity—to estimate potential increases in mortality and morbidity outcomes immediately following the MLDA.
Results. We found that in comparison to youth slightly younger than the MLDA, those just older than the MLDA had significant increases in: national inpatient admissions for alcohol-use disorders/poisoning for males (17%) and females (21%), as well as for suicide events for the combined sample (9.6%), and among males in a broad class of injuries (4.4%), including MVCs (9.2%); inpatient/Emergency Department admissions in Ontario for alcohol-use disorders (10.8%), assaults (7.9%), and suicide (51.8%); national all-cause mortality (for males) in provinces/territories with an MLDA of 18 years of age (14.2%), and 19 years of age (7.2%); and population-level MVCs in Québec (6.2%).
Conclusions. The MLDA has a powerful effect on a range of serious morbidity and mortality outcomes. This line of research demonstrates the usefulness of the regression-discontinuity approach for estimating the impacts of contemporary MLDA legislation. Also, it is reasonable to argue that an increase in the MLDA would result in a reduction in morbidity and mortality outcomes among individuals under the newly raised drinking age.