Alcohol has been widely used in many cultures for centuries across several continents. Although alcohol is classified as a depressant, hence its use is frequently associated with turmoil and emotional times, its effects vary from person to person. Alcohol is a commonly abused drug which can lead to social and economic burdens. Worldwide, 3.3 million deaths every year result from alcohol abuse, which represents 5.9% of all deaths. The harmful use of alcohol is an originating factor in more than 200 diseases and injury conditions, according to the World Health Organization (WHO). Its production, availability and ease of access varies from country to country and depends on the relevant rules and regulations set by the responsible governing bodies.

Due to the social and health impact of alcohol abuse and due to the fact that there is a lack of prominent studies exploring the impact of alcohol sales laws on health, a team of researchers based at the University of California, San Francisco, investigated the relation between alcohol consumption and cardiovascular disease by comparing alcohol sale laws in different counties in Texas. The study was published in the British Medical Journal yesterday.

The team of researchers decided to investigate Texas since it is the most populous US state to pass laws restricting alcohol sales. Counties that allow alcohol sale are known as wet counties, and the ones that restrict alcohol sales are known as dry counties.

Methodology

The researchers identified 29 counties as dry, 47 counties as wet and seven counties changed their laws to convert from dry to wet between 2005 and 2010, using data from the Texas Alcoholic Beverage Commission. The researchers also obtained all county-wide and municipal local option election records from 1937 to 2010 from the same source and reviewed them to validate a county’s alcohol sales status.

The researchers conducted two test analyses. Firstly, they compared the health outcomes of patients living in wet and dry counties. Secondly, they investigated the health outcomes of patients living in counties that changed their status from dry to wet, before and after the policy change. The team did not include counties with partial alcohol ban or where alcohol laws had changed during the trial period. During that time period the researchers discovered 1,106,968 patients aged 21 or older admitted to hospital in the state, using data from the Texas Department of State Health Services.

The primary outcomes the researchers were investigating was an increase in heart disease which included atrial fibrillation, acute myocardial infarction and congestive heart failure. The researchers used the Texas Inpatient Research Data File obtained from the Texas Department of State Health Services (Austin, TX) to identify all patients older than 21 years admitted to a hospital in the state of Texas between 1 January, 2005, and 31 December, 2009. The team did not include patients with missing data or had residence outside of Texas.

Results

The results showed that alcohol abuse and alcohol-related liver disease was significantly greater in wet counties than in dry counties even after adjusting for factors such as race, ethnicity, age and sex. There was also a higher frequency of patients with atrial fibrillation, which is the most common type of heart arrhythmia, a problem with the rate or rhythm of heartbeat.

What was remarkable about the study was that although there was a higher incidence of patients with atrial fibrillation, there was a lower incidence and prevalence of heart attacks and congestive heart failures. Patients residing in counties that changed their status from dry to wet also showed a higher risk for alcohol misuse, alcoholic liver disease, atrial fibrillation, and congestive heart failure, with no observable change in the rate of heart attacks.

Comparison With Other Studies

Previous studies suggest that higher alcohol consumption increases cardiovascular disease risk while at the same time lowering risk of other diseases. Most of these studies have relied on self-reported alcohol use and have some degree of errors in them. Secondly, alcohol consumption among participants is done on the user’s own responsibility, which creates difficulty in extracting data and identifying the link between alcohol consumption and other related behaviors, decisions and exposures that may serve as important factors. This study eliminates all potential errors that are associated with self-reporting. In fact, the study limits conflicting factors and purely focuses on the impact of alcohol sales regulations on health.

Limitations Of The Study

There were however some limitations to the study. The laws only prevent the sale of alcohol and not its transport or consumption which may affect the results observed in dry counties. The myocardial infarctions reported were done using inbound patients and did not consider out of hospital myocardial infarctions, episodes of atrial fibrillation and congestive heart failure treated in emergency departments or outpatient clinics. Also some differences in socio-economic status could account for the difference in results observed in the dry and wet counties, since the researchers did not adjust this factor.

This study proved that that laws limiting alcohol sales have measurable public health effects. Increased access to alcohol was consistently associated with more atrial fibrillation and less myocardial infarction. Since alcohol is the number one abused drug in US and heart disease is the most common cause of death, according to WHO, the study gives ample evidence for people at risk of heart disease. Most importantly the study showed that public laws limiting access to a commonly consumed substance have vital health impact that may be both harmful and beneficial.