Access to alcohol and heart disease among patients in hospital: observational cohort study using differences in alcohol sales laws.
OBJECTIVE
To investigate the relation between alcohol consumption and heart disease by using differences in county level alcohol sales laws as a natural experiment.


METHODS
Observational cohort study using differences in alcohol sales laws.


METHODS
Hospital based healthcare encounters in Texas, USA.


METHODS
1 106 968 patients aged 21 or older who were residents of "wet" (no alcohol restrictions) and "dry" (complete prohibition of alcohol sales) counties and admitted to hospital between 2005 and 2010, identified using the Texas Inpatient Research Data File.


METHODS
Prevalent and incident alcohol misuse and alcoholic liver disease were used for validation analyses. The main cardiovascular outcomes were atrial fibrillation, acute myocardial infarction, and congestive heart failure.


RESULTS
Residents of wet counties had a greater prevalence and incidence of alcohol misuse and alcoholic liver disease. After multivariable adjustment, wet county residents had a greater prevalence (odds ratio 1.05, 95% confidence interval 1.01 to 1.09; P=0.007) and incidence (hazard ratio 1.07, 1.01 to 1.13; P=0.014) of atrial fibrillation, a lower prevalence (odds ratio 0.83, 0.79 to 0.87; P<0.001) and incidence (hazard ratio 0.91, 0.87 to 0.99; P=0.019) of myocardial infarction, and a lower prevalence (odds ratio 0.87, 0.84 to 0.90; P<0.001) of congestive heart failure. Conversion of counties from dry to wet resulted in statistically significantly higher rates of alcohol misuse, alcoholic liver disease, atrial fibrillation, and congestive heart failure, with no detectable difference in myocardial infarction.


CONCLUSIONS
Greater access to alcohol was associated with more atrial fibrillation and less myocardial infarction and congestive heart failure, although an increased risk of congestive heart failure was seen shortly after alcohol sales were liberalized.
Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Ave, M-1180B, Box 0124, San Francisco, CA 94143-0124, USA.
Jonathan W
JW
Dukes
Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA.
Thomas A
TA
Dewland
Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
Eric
E
Vittinghoff
Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Ave, M-1180B, Box 0124, San Francisco, CA 94143-0124, USA.
Jeffrey E
JE
Olgin
Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA.
Mark J
MJ
Pletcher
Department of Medicine, University of California, San Francisco, CA, USA.
Judith A
JA
Hahn
Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Ave, M-1180B, Box 0124, San Francisco, CA 94143-0124, USA.
Rachel A
RA
Gladstone
Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Ave, M-1180B, Box 0124, San Francisco, CA 94143-0124, USA.
Gregory M
GM
Marcus
D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000331:legislation & jurisprudence*; D000437:Alcoholism / Q000150:complications / Q000453:epidemiology*; D001281:Atrial Fibrillation / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008108:Liver Diseases, Alcoholic / Q000150:complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology