Washington’s Liquor License System and Alcohol‐Related Adverse Health Outcomes
Abstract
Background and Aims
In June 2012, Washington state (USA) implemented Initiative 1183, privatizing liquor sales. As a result, off‐premises outlets increased from 330 to over 1400 and trading hours lengthened. Increased availability of liquor may lead to increased consumption. This study examines the impact of Initiative 1183 on alcohol‐related adverse health outcomes, measured by inpatient hospitalizations for alcohol‐related disorders and accidental injuries. It further assesses heterogeneity by urbanicity, because outlets increased most in metropolitan‐urban areas.
Design
County‐by‐quarter difference‐in‐difference linear regression models, estimated statewide and within metropolitan/rural strata.
Setting and Participants
Data are from AHRQ Healthcare Cost and Utilization State Inpatient Database 2010 – 2014 and HHS Area Health Resource File 2010 – 2014. Changes in the rates of hospitalizations in the 2.5 years following Initiative 1183 in Washington (n = 39 counties) are compared with changes in Oregon (n = 36 counties).
Measurements
County rates of hospitalizations per 1000 residents, including all records with any‐listed ICD‐9 Clinical Classification Software code denoting an alcohol‐related disorder, and all records with any‐listed external cause of injury code denoting an accidental injury.
Findings
The increase in the rate of accidental injury hospitalizations in Washington’s metropolitan‐urban counties was on average 0.289 hospitalizations per 1000 county residents per quarter greater than the simultaneous increase observed in Oregon (P = 0.017). This result was robust to alternative specifications using a propensity score matched sample and synthetic control methods with data from other comparison states. The evidence did not suggest that Initiative 1183 was associated with differential changes in the rate of hospitalizations for alcohol‐related disorders in metropolitan‐urban (P = 0.941), non‐metropolitan‐urban (P = 0.162), or rural counties (P = 0.876).
Conclusions
Implementing Washington’s Initiative 1183 (privatizing liquor sales) appears to have been associated with a significant increase in the rate of accidental injury hospitalizations in urban counties in that state but does not appear to be significantly associated with changes in the rate of hospitalizations specifically for alcohol‐related disorders within 2.5 years.
Study in context
According to this study after privatizing liquor sales there were an additional 17,498 hospitalizations in metropolitan-urban counties 2.5 years after it was implemented. All of these hospitalizations were due to alcohol-related accidental injury.
It was surprising that hospitalization rates for accidental injuries increased despite the rise in liquor prices, which were substantially higher than before the initiative was passed. We expected higher prices might inhibit sales and consumption, so this result shows how strong of an influence the increased availability of liquor had,” said Dr. Aryn Phillips, lead author of the study and a postdoctoral researcher at the Northwestern University Feinberg School of Medicine, as per, Alcohol Research Group Website.
With more states in the U.S. considering privatization of alcohol sales, this work is critical to determine what the real cost of such a change might be. It’s not enough to only look at sales data – we need to understand how it impacts the health of individuals and the larger community,” added Dr. Philips
Dr. Aryn Phillips, lead author of the study, postdoctoral researcher at the Northwestern University Feinberg School of Medicine
As highlighted by the Alcohol Research Group, the finding that hospitalizations due to alcohol-related disorders did not increase is possibly because in the short-term there may be no observable increase in these disorders while accidents show short-term effect. The study would have to be conducted a few years later to observe the effect the policy decision had on alcohol-related disorders.
