Associations of minimum legal drinking age law with later-life alcohol use and alcohol-attributable mortality from disease and injury: An ecological study

Jie Li; Peishan Ning; Wanhui Wang; David C. Schwebel; Li Li; Zhenzhen Rao; Peixia Cheng; Dan Tian; Guoqing Hu

doi:10.1016/j.cjtee.2026.01.007

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Associations of minimum legal drinking age law with later-life alcohol use and alcohol-attributable mortality from disease and injury: An ecological study

Journal article

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Associations of minimum legal drinking age law with later-life alcohol use and alcohol-attributable mortality from disease and injury: An ecological study

Jie Li, Peishan Ning, Wanhui Wang, David C. Schwebel, Li Li, Zhenzhen Rao, Peixia Cheng, Dan Tian and Guoqing Hu

Chinese journal of traumatology

04/2026

DOI: 10.1016/j.cjtee.2026.01.007

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Abstract

To examine associations of minimum legal drinking age (MLDA) laws with later-life alcohol use and alcohol-attributable mortality. An ecological study was performed using the free-access data from the United States. Five outcome measures were considered: (1) drinking rate, (2) alcohol consumption per capita, and alcohol-attributable mortality for (3) all diseases and injuries, (4) non-injury diseases, and (5) injuries. Univariate statistical tests compared differences in 5 outcome measures during 1990-2021 across 3 types of states, classified based on different MLDA beer laws in 1970–1988. Multivariable regression examined MLDA laws’ associations with 5 outcome variables, adjusting for covariates. Sensitivity analyses used MLDA classifications for wine and spirits. Based on MLDA beer laws of 1970–1988, the 50 states and the District of Columbia were classified as Type 1 (increasing MLDA), Type 2 (fluctuating MLDA), and Type 3 (steady MLDA of 21). For all years combined, Type 1 and Type 2 states had lower and higher drinking rates (51.05% and 55.20% vs. 53.23%) and alcohol consumption per capita (463.26 and 511.57 vs. 483.92 standard drinks). Compared to Type 2 and Type 3 states, Type 1 states had the highest alcohol-attributable injury mortality for Americans aged 30 years and older (4.30 vs. 3.93 and 3.87 per 100,000). After adjusting for the included covariates, 3 types of states demonstrated differing trends in drinking rate and alcohol-attributable injury mortality but highly similar trends in the other 3 outcome measures. Sensitivity analyses generated similar findings. MLDA was associated with later-life alcohol use and alcohol-attributable mortality.

United States

Alcohol

Alcohol policy

Minimum legal drinking age

Mortality

Details

Title: Subtitle: Associations of minimum legal drinking age law with later-life alcohol use and alcohol-attributable mortality from disease and injury: An ecological study
Creators: Jie Li - Hunan Provincial Key Laboratory of Philosophy and Social Sciences of Urban Smart Governance, Changsha 410083, China
Peishan Ning - Central South University
Wanhui Wang - Central South University
David C. Schwebel - Office of Research, University of Iowa, Iowa City, Iowa 52242, United States of America
Li Li - Central South University
Zhenzhen Rao - Central South University
Peixia Cheng - Capital Medical University
Dan Tian - Central South University
Guoqing Hu - Central South University
Resource Type: Journal article
Publication Details: Chinese journal of traumatology
DOI: 10.1016/j.cjtee.2026.01.007
ISSN: 1008-1275
Publisher: Elsevier B.V
Language: English
Electronic publication date: 04/2026
Academic Unit: Research Administration; Psychological and Brain Sciences
Record Identifier: 9985153546602771

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