Health Disparities in Alcohol-related Risks for Injuries, Diabetes, and Cardiovascular Morbidity and Mortality The focus of this Center Project is on analyses of selected major causes of illness, injury, disability and death where significant racial/ethnic and socioeconomic disparities are evident in the US and which are substantially alcohol-related. Proposed analyses will extend prior and ongoing research programs led by PI Kerr and Dr. Cherpitel focusing on injuries and unintentional injury and motor vehicle crash subtypes which have high mortality rates in all racial/ethnic groups, particularly for those under age 40, and on diabetes, hypertension and heart problems, which are prevalent and inter-related diseases, conditions and causes of death with large racial/ethnic and socioeconomic disparities. Our goals are to provide the details of recent health disparities in these major alcohol-related causes and to analyze the roles of alcohol use patterns for these health risks to improve understanding of the role of alcohol and the potential for reducing morbidity, mortality and disparities through alcohol policy, prevention efforts and treatment. There has been very limited research on the potential roles of racial and ethnic differences in life-course drinking and alcohol-related problems in health disparities. Data sources are the Behavioral Risk Factor Surveillance System, the National Alcohol Surveys (NAS) and State-level mortality data from the National Center for Health Statistics. Analyses will primarily focus on Black and Latino groups as compared to a White reference group with NAS analyses also considering socioeconomic disparities and some mortality analyses also considering Asian and Pacific Islander and American Indian and Alaska Native groups. Mortality analyses will focus on major acute and chronic causes with significant racial/ethnic disparities and alcohol involvement: unintentional injuries and the subtype of motor vehicle crashes and cardiovascular-related areas of ischemic heart disease (IHD), hypertension and diabetes. The proposed study will evaluate risks for health outcomes among NAS respondents and will detail disparities in mortality rates and model relationships with sub-group drinking patterns from the BRFSS. Key innovations will include attention to life-course alcohol patterns in the NAS addressing the endogeniety of drinking and health and associations between alcohol patterns and other health risk behaviors, attention of beverage- specific associations in the NAS and consideration of state linked alcohol tax-based instrumental variable (IV) methods for causal effects. Alcohol tax measures are new estimates of spirits, wine and beer tax rates developed by PI Kerr that allow for the inclusion of spirits control states and ad valorem taxes in a framework where all tax rates are converted to equivalent wholesale-level beverage volume excise tax rates. This innovation improves the accuracy of tax rates allows the inclusion of 18 spirits control states providing greater variability over the period of analyses, which should significantly improve the performance of the IV models. Results will identify and quantify disparities in alcohol patterns and alcohol pattern risk relationships with morbidity and mortality, testing hypotheses regarding differential risks.
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