Minimum legal drinking age and alcohol-attributable morbidity and mortality by age 63 years: a register-based cohort study based on alcohol reform
The Lancet Public Health, 8:5, e339–e346 (2023)
Background: Minimum legal drinking age (MLDA) is an effective policy tool in preventing youth drinking and short-term alcohol-attributable harm, but studies concerning long-term associations are scarce.
Methods: In this register-based, national cohort study, we assessed alcohol-attributable morbidity and mortality of cohorts born in 1944–54 in Finland. Data were from the 1970 census, the Care Register for Healthcare (maintained by the Finnish Institute of Health and Welfare), and the Cause-of-Death Register (maintained by Statistics Finland). As MLDA was lowered from 21 years to 18 years in 1969, these cohorts were effectively allowed to buy alcohol from different ages (18–21 years). We used survival analysis to compare their alcohol-attributable mortality and hospitalisations with a 36-year follow-up.
Findings: Compared with the first cohort (1951) allowed to buy alcohol from age 18, the hazard ratios (HRs) for alcohol-attributable morbidity and mortality were lower in cohorts who could not buy alcohol until age 20 or 21 years. For alcohol-attributable morbidity in those aged 21 years when the reform took place, HR was 0·89 (95% CI 0·86–0·93) for men and 0·87 (0·81–0·94) for women versus those aged 17 years. For alcohol-attributable mortality, HR was 0·86 (0·79–0·93) for men and 0·78 (0·66–0·92) for women aged 21 years when the reform took place. The outcomes of the later-born 1952–54 cohorts did not differ from the 1951 cohort.
Interpretation: Earlier cohorts had consistently lower alcohol-attributable mortality and morbidity; however, other simultaneous increases in alcohol availability probably contributed to increased alcohol-related harm among the younger cohorts. Overall, differences between cohorts born only a few years apart highlight late adolescence as a crucial period for the establishment of lifelong patterns of alcohol use and suggest that higher MLDA could be protective for health beyond young adulthood.