The Impact of the Minimum Legal Drinking Age on Alcohol-Related Chronic Disease Mortality

Alcohol Clin Exp Res. 2016 Aug;40(8):1761-8. doi: 10.1111/acer.13123. Epub 2016 Jun 24.


Background: The minimum legal drinking age (MLDA) of 21 has been associated with a number of benefits compared to lower MLDAs, including long-term effects, such as reduced risk for alcoholism in adulthood. However, no studies have examined whether MLDA during young adulthood is associated with mortality later in life. We examined whether individuals exposed to permissive MLDA (<21) had higher risk of death from alcohol-related chronic disease compared to those exposed to the 21 MLDA. Because prior work suggests that MLDA affects college students differently, we also conducted conditional analyses based on ever having attended college.

Methods: Data from the 1990 through 2010 U.S. Multiple Cause-of-Death files were combined with data on the living population and analyzed. We included individuals who turned 18 during the years 1967 to 1990, the period during which MLDA varied across states. We examined records on death from several alcohol-related chronic diseases, employing a quasi-experimental approach to control for unobserved state characteristics and stable time trends.

Results: Individuals who reported any college attendance did not exhibit significant associations between MLDA and mortality for the causes of death we examined. However, permissive MLDA for those who never attended college was associated with 6% higher odds for death from alcoholic liver disease, 8% higher odds for other liver disease, and 7% higher odds for lip/oral/pharynx cancers (odds ratio [OR] = 1.06, 95% confidence interval [CI] [1.02, 1.10]; OR = 1.08, 95% CI [1.03, 1.13]; OR = 1.07, 95% CI [1.03, 1.12], respectively).

Conclusions: The 21 MLDA likely protects against risk of death from alcohol-related chronic disease across the lifespan, at least for those who did not attend college. This is consistent with other work that shows that the long-term association between MLDA and alcohol-related outcomes is specific to those who did not attend college.

Keywords: Alcoholic Liver Disease; Cancer; College Drinking; Minimum Legal Drinking Age; Mortality.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Alcohol Drinking / legislation & jurisprudence*
  • Alcohol Drinking / mortality*
  • Alcohol Drinking / trends
  • Alcohol-Related Disorders / diagnosis*
  • Alcohol-Related Disorders / mortality*
  • Chronic Disease
  • Databases, Factual / trends
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mortality / trends
  • Underage Drinking* / trends
  • United States / epidemiology
  • Young Adult