摘要：Objective. We evaluated the effects of tax increases on alcoholic beverages in 1983 and 2002 on alcohol-related disease mortality in Alaska. Methods. We used a quasi-experimental design with quarterly measures of mortality from 1976 though 2004, and we included other states for comparison. Our statistical approach combined an autoregressive integrated moving average model with structural parameters in interrupted time-series models. Results. We observed statistically significant reductions in the numbers and rates of deaths caused by alcohol-related disease beginning immediately after the 1983 and 2002 alcohol tax increases in Alaska. In terms of effect size, the reductions were –29% (Cohen's d = –0.57) and –11% (Cohen's d = –0.52) for the 2 tax increases. Statistical tests of temporary-effect models versus long-term-effect models showed little dissipation of the effect over time. Conclusions. Increases in alcohol excise tax rates were associated with immediate and sustained reductions in alcohol-related disease mortality in Alaska. Reductions in mortality occurred after 2 tax increases almost 20 years apart. Taxing alcoholic beverages is an effective public health strategy for reducing the burden of alcohol-related disease. Morbidity and mortality associated with consumption of alcoholic beverages constitute a substantial public health burden in the United States. An estimated 85 000 deaths per year are associated with drinking, including car crashes, other unintentional injuries, homicide, suicide, and a range of diseases, particularly those affecting the liver, pancreas, and heart. 1 – 3 All states have taxes specific to alcoholic beverages; some of these taxes are imposed primarily to generate revenue, 4 whereas others are ostensibly intended to promote public health and welfare by limiting alcohol consumption. 5 , 6 More than 100 studies have examined the relationship between alcoholic beverage prices (or alcohol tax rates as a surrogate for prices) and various indices of sales or consumption of alcohol (see Babor et al. 7 and Chaloupka et al. 8 for recent reviews). With a few exceptions (e.g., Salomaa 9 ), studies consistently find price or tax levels to be inversely related to sales or consumption of alcoholic beverages, with the magnitude of the effect in terms of elasticities ranging from –0.2 to –2.0, depending on population, methods, time period, and specific beverage. Substantially fewer studies have examined the effects of alcohol prices or taxes on measures of alcohol-related morbidity or mortality, and of those that have, most have focused on injury rather than disease. Of 18 studies that examined price or tax effects on traffic crashes, 15 found that higher alcohol prices or taxes were associated with fewer crashes, 10 – 24 but 3 found no effect. 25 – 27 Sloan et al. 25 found that alcohol prices were not related to falls, fires, or other unintentional injury rates, but Ohsfeldt and Morrisey 28 found that higher beer taxes were related to lower rates of nonfatal industrial injuries. In addition, 8 studies (6 of which were conducted by 1 research team) found higher alcohol prices or taxes associated with lower morbidity or mortality from intentional injuries, including assault, homicide, suicide, child abuse, and spouse abuse. 29 – 36 However, 1 of these studies found that higher beer taxes were not specifically related to levels of robbery or rape. 31 Finally, a number of studies have found higher alcohol prices or taxes to be associated with lower rates of alcohol dependence 37 , 38 and liver cirrhosis. 23 , 39 – 42 In contrast, Schweitzer et al. 43 did not find a significant relationship between alcohol prices and rates of alcohol dependence. To elicit more information about the effect of alcoholic beverage taxes on disease mortality, we examined patterns of alcohol-related disease mortality in the state of Alaska over a 29-year period to determine whether 2 major increases in alcohol tax rates, 1 in 1983 and the other in 2002, affected alcohol-related mortality in the state.
