TOPLINE

Reaching legal drinking age thresholds was associated with sharp short-term increases in mortality, accidental deaths, and hospitalisations for suicide attempts among young adults, according to a nationwide study in Finland.

METHODOLOGY

• Researchers conducted a quasi-experimental regression discontinuity (RD) study examining nationwide administrative register data of approximately 3,000,000 individuals born between 1955 and 1998 who were living in Finland.
• The study evaluated health outcomes at 12 months before and after individuals reached legal alcohol thresholds at the age of 18 years (beer, wine, on-premises drinking, and a driving license) and the age of 20 years (off-premises spirits).
• Outcomes were all-cause, external cause, alcohol-contributed, and accidental mortality and hospitalisations for external causes, alcohol-related reasons, traffic accidents, and suicide attempts, measured as monthly rates per 100,000 person-months.
• Regression models evaluated men and women cohorts separately to capture sex-specific differences in acute health impacts across age thresholds.
• Register-based driving license data were used in robustness analyses to control for driving license status at the age of 18 years, allowing the researchers to gauge the contribution of increased driving and legal alcohol access.

TAKEAWAY

• Reaching the legal drinking age of 18 years was associated with a 26.9% rise in all-cause mortality among men (RD, 1.62 per 100,000 person-months; P < .001), driven partly by an approximately 35% rise in alcohol-contributed deaths (RD, 0.65 per 100,000 person-months; P = .015), and a low baseline rise in alcohol-contributed deaths was observed among women (RD, 0.18 per 100,000 person-months; P = .084).
• At 18 years, external cause and accidental deaths were tied to a 45% rise (RD, 2.03 per 100,000 person-months) and a 61% rise (RD, 1.49 per 100,000 person-months), respectively, in men (P < .001 for both); hospitalisations for accidents were tied to a 37% rise in men and a 59% rise in women (RD, 4.79 and 3.48 per 100,000 person-months, respectively), and among women, hospitalisations for external causes broadly were tied to a 13% rise (RD, 5.30 per 100,000 person-months; P = .001).
• Legal access to off-premises spirits at the age of 20 years was linked to increases in alcohol-contributed deaths in men, which rose to 39.5% (RD, 0.88 per 100,000 person-months); accidental deaths increased to 19.3% (RD, 0.54 per 100,000 person-months).
• Among women, turning 20 years was associated with an 18.9% rise in hospitalisations for suicide attempts (RD, 1.11 per 100,000 person-months; P = .029).

IN PRACTICE

"[Our findings] highlight the need to consider the immediate behavioral responses triggered by age-based alcohol policies, especially when they coincide with other age-specific entitlements such as driving licenses," the authors wrote.

"Strengthening the coordination of alcohol regulation, road safety measures and targeted prevention around legal age transitions may help mitigate these risks and improve public health outcomes," they added.

SOURCE

The study was led by Petri Böckerman, University of Jyväskylä, Jyväskylä, Finland. It was published online on July 28, 2026, in Addiction.

LIMITATIONS

The study was limited by its age-based RD design identifying short-run local treatment effects near thresholds, the coincidence of drinking and driving license ages at 18 years, the lack of direct measures for individual alcohol consumption or informal underage access. The study was further limited by the reliance on data specific to Finland's strict alcohol monopoly system, limiting generalisability to settings with weaker regulation or more permissive norms around underage drinking.

DISCLOSURES

The study received support from the Finnish Foundation for Alcohol Studies, the Finnish Cultural Foundation, the Yrjö Jahnsson Foundation, and the OP Group Research Foundation. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.