Per capita alcohol consumption and ischemic heart disease mortality in a panel of US states from 1950 to 2002

Aims To estimate the overall impact of alcohol on ischemic heart disease (IHD) mortality in the United States using aggregate-level models and to consider beverage-specific effects that may represent more effectively the changes in drinking patterns over time that are related to both harmful and protective impacts of alcohol consumption on IHD. Design Several model specifications are estimated, including state-specific autoregressive integrated moving average (ARIMA) models and generalized least squares (GLS) panel models on first-differenced data. Setting US states from 1950 to 2002. Participants US general population. Measurements Per capita alcohol sales and cigarette sales, age-standardized IHD and cirrhosis mortality rates. Findings Apparent consumption of total alcohol was associated with a significant overall increase of IHD of about 1% mortality per litre of ethanol. Beverage-specific models found that spirits consumption was significantly positively related to IHD mortality overall, for both genders and in three regions defined by drinking culture (or 'wetness'), while beer was found to have a significant protective relationship overall and in the wet region. The results for wine also suggest a protective relationship, but only marginally significant effects were found. Cirrhosis mortality rates were consistently positively related to IHD mortality. Combined results from state-specific ARIMA models including both cigarette sales and cirrhosis rates were generally consistent with the GLS results. Conclusions Population-level models confirm individual-level findings of both harmful and protective relationships between alcohol use patterns and ischemic heart disease mortality. However, an overall harmful impact of per capita alcohol consumption on IHD mortality was found.