Washington's liquor license system and alcohol-related adverse health outcomes

Abstract

Background and aims: In June 2012, Washington state (USA) implemented Initiative 1183, privatizing liquor sales. As a result, off-premises outlets increased from 330 to over 1400 and trading hours lengthened. Increased availability of liquor may lead to increased consumption. This study examines the impact of Initiative 1183 on alcohol-related adverse health outcomes, measured by inpatient hospitalizations for alcohol-related disorders and accidental injuries. It further assesses heterogeneity by urbanicity, because outlets increased most in metropolitan-urban areas.

Design: County-by-quarter difference-in-difference linear regression models, estimated statewide and within metropolitan/rural strata.

Setting and participants: Data are from AHRQ Healthcare Cost and Utilization State Inpatient Database 2010-2014 and HHS Area Health Resource File 2010-2014. Changes in the rates of hospitalizations in the 2.5 years following Initiative 1183 in Washington (n = 39 counties) are compared with changes in Oregon (n = 36 counties).

Measurements: County rates of hospitalizations per 1000 residents, including all records with any-listed ICD-9 Clinical Classification Software code denoting an alcohol-related disorder, and all records with any-listed external cause of injury code denoting an accidental injury.

Findings: The increase in the rate of accidental injury hospitalizations in Washington's metropolitan-urban counties was on average 0.289 hospitalizations per 1000 county residents per quarter greater than the simultaneous increase observed in Oregon (P = 0.017). This result was robust to alternative specifications using a propensity score matched sample and synthetic control methods with data from other comparison states. The evidence did not suggest that Initiative 1183 was associated with differential changes in the rate of hospitalizations for alcohol-related disorders in metropolitan-urban (P = 0.941), non-metropolitan-urban (P = 0.162), or rural counties (P = 0.876).

Conclusions: Implementing Washington's Initiative 1183 (privatizing liquor sales) appears to have been associated with a significant increase in the rate of accidental injury hospitalizations in urban counties in that state but does not appear to be significantly associated with changes in the rate of hospitalizations specifically for alcohol-related disorders within 2.5 years.

Keywords: Accidental injuries; alcohol-related disorders; hospitalizations; liquor availability; privatization; state policy.

Figure 1.

Off-premise outlets in WA before (2012) and after (2014) Initiative 1183 Implementation

Figure 2.

Off-premise outlet location & density in WA after Initiative 1183 Implementation

Figure 3.

Alcohol-related disorder hospitalization rates in Washington & Oregon before and after 1183 implementation

Figure 4.

Accidental injury hospitalization rates in Washington & Oregon before and after 1183 implementation

Figure 5.

Accidental injury hospitalization rates in metropolitan-urban counties in Washington & matched sample before and after 1183 implementation

Figure 6.

Accidental injury hospitalization rates in metropolitan-urban counties in Washington & synthetic control before and after 1183 implementation