Abstract
AIMS: The aim of this study was to estimate the overall impact of alcohol on US race- and sex-specific age-adjusted cirrhosis mortality rates and to consider beverage-specific effects that represent changes in drinking patterns over time, comparing states with large and small African-American/White cirrhosis mortality differentials. METHODS: Using series data from 1950 to 2002, the effects of per capita alcohol consumption on cirrhosis mortality for African American and White men and women were estimated using generalized least squares panel models on first-differenced data. Granger causality tests explored geographic patterning of racial differences in cirrhosis mortality. RESULTS: Cirrhosis mortality was significantly positively related to apparent consumption of alcohol, with an overall impact of 8-14%/l of ethanol. This effect was driven by spirits which were more strongly associated with mortality for African-American women and for African-American men in states with larger mortality differentials. This disparity first emerged in New York and spread through the Northeast and into Midwestern states. CONCLUSION: Differences in the contribution of alcohol to cirrhosis mortality rates suggest variation by race and gender in life-course patterns of heavy consumption, illicit liquor and spirits use, as well as birth cohort effects.