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

Aims To estimate the association between per capita alcohol retail outlet density and blood alcohol concentration ( BAC ) from 51 547 suicide decedents and to analyse the relationship between alcohol outlet density and socio‐demographic characteristics among alcohol‐positive suicide decedents in the U nited S tates by racial/ethnic groups and method of suicide. Design Analysis of US data, 2003–11, N ational V iolent D eath R eporting S ystem. Setting Suicide decedents from 14 US states. Participants A total of 51 347 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 C ensus. 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 A merican I ndian/ A laska N ative 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 A merican I ndians/ A laska N atives.