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As the USA alcoholic beverage distribution system generally requires international brands to import their beverages through a registered import business, used licensed distribution companies and sell through separate retail entities, small and medium sized brand owners often find it difficult to penetrate the Three Tier System

The death rate for the Black community in 2006 was 6.2 people per 100,000 persons, in 2019 it was 7.5 people per 100,000

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Ethics and inclusion The study used publicly available, de-identified data on mortality and risk factors, and no ethical permission was needed