Vital Signs: Alcohol Poisoning Deaths — United States, 2010–2012

Dafna Kanny, PhD; Robert D. Brewer, MD; Jessica B. Mesnick, MPH; Leonard J. Paulozzi, MD; Timothy S. Naimi, MD; Hua Lu, MS

Disclosures

Morbidity and Mortality Weekly Report. 2015;63(53):1238-1242.

Abstract and Introduction

Abstract

Background Alcohol poisoning is typically caused by binge drinking at high intensity (i.e., consuming a very large amount of alcohol during an episode of binge drinking). Approximately 38 million U.S. adults report binge drinking an average of four times per month and consuming an average of eight drinks per episode.

Methods CDC analyzed data for 2010–2012 from the National Vital Statistics System to assess average annual alcohol poisoning deaths and death rates (ICD-10 codes X45 and Y15; underlying cause of death) in the United States among persons aged ≥15 years, by sex, age group, race/ethnicity, and state.

Results During 2010–2012, an annual average of 2,221 alcohol poisoning deaths (8.8 deaths per 1 million population) occurred among persons aged ≥15 years in the United States. Of those deaths, 1,681 (75.7%) involved adults aged 35–64 years, and 1,696 (76.4%) involved men. Although non-Hispanic whites accounted for the majority of alcohol poisoning deaths (67.5%; 1,500 deaths), the highest age-adjusted death rate was among American Indians/Alaska Natives (49.1 per 1 million). The age-adjusted rate of alcohol poisoning deaths in states ranged from 5.3 per 1 million in Alabama to 46.5 per 1 million in Alaska.

Conclusions On average, six persons, mostly adult men, die from alcohol poisoning each day in the United States. Alcohol poisoning death rates vary substantially by state.

Implications for Public Health Practice Evidence-based strategies for preventing excessive drinking (e.g., regulating alcohol outlet density and preventing illegal alcohol sales in retail settings) could reduce alcohol poisoning deaths by reducing the prevalence, frequency, and intensity of binge drinking.

Introduction

Excessive alcohol use accounted for an average of one in 10 deaths among working-age adults (aged 20–64 years) in the United States each year during 2006–2010,^[1] and cost the United States $223.5 billion in 2006.^[2] Binge drinking, defined as consuming four or more drinks for women or five or more drinks for men on an occasion, was responsible for more than half of these deaths^[1] and three fourths of the economic costs.^[2] Binge drinking also is responsible for many health and social problems, including alcohol poisoning.^[3] Yet, approximately 38 million U.S. adults report binge drinking an average of four times per month, and consume an average of eight drinks per binge episode .^[4] Most binge drinkers (90%) are not alcohol dependent.^[5]

Alcohol poisoning is typically caused by binge drinking at high intensity. Such drinking can exceed the body's physiologic capacity to process alcohol, causing the blood alcohol concentration to rise. The clinical signs and symptoms of alcohol intoxication are progressive, and range from minimal impairment, decreased judgment and control, slurred speech, reduced muscle coordination, vomiting, and stupor (reduced level of consciousness and cognitive function) to coma and death. However, an individual's response to alcohol is variable depending on many factors, including the amount and rate of alcohol consumption, health status, consumption of other drugs, and metabolic and functional tolerance of the drinker.^[6,7]

Reducing the proportion of adults engaging in binge drinking (objective SA-14.3) and reducing the number of deaths attributable to alcohol (objective SA-20), including deaths from alcohol poisoning, are among the objectives in Healthy People 2020.^[8] Reducing drug abuse and excessive alcohol use are also key components of the National Prevention Strategy.^[9]

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Table 1. Alcohol poisoning deaths,* by sex, age group, and race/ethnicity — National Vital Statistics System, United States, 2010–2012
Characteristic	Total			Male			Female
Characteristic	Average annual no. of deaths	% of total deaths	Age-adjusted rate^†	Average annual no. of deaths	% of male deaths	Age-adjusted rate^†	Average annual no. of deaths	% of female deaths	Age-adjusted rate^†
Overall	2,221	100.0	8.8	1,696	100.0	13.7	525	100.0	4.1
Age group ^§ (yrs)
15–24	113	5.1	2.6	85	5.0	3.8	28	5.4	1.3
25–34	288	13.0	6.9	228	13.4	10.9	60	11.4	2.9
35–44	476	21.4	11.7	370	21.8	18.2	106	20.2	5.2
45–54	747	33.6	16.7	564	33.3	25.6	183	34.8	8.1
55–64	458	20.6	12.2	352	20.7	19.3	107	20.3	5.5
≥65	139	6.3	3.3	98	5.8	5.4	41	7.9	1.8
Race/Ethnicity
White, non-Hispanic	1,500	67.5	8.8	1,103	65.0	13.1	397	75.6	4.6
Black, non-Hispanic	191	8.6	6.2	149	8.8	10.6	42	8.1	2.6
Hispanic	338	15.2	9.0	296	17.5	15.6	41	7.9	2.4
American Indian/Alaska Native	154	6.9	49.1	114	6.7	75.0	39	7.5	24.3
Asian/Pacific Islander	32	1.5	2.2	28	1.7	4.1	4	0.8	—^¶

*Alcohol poisoning deaths included those occurring among persons aged ≥15 years in which alcohol poisoning was classified as the underlying (i.e., principal) cause of death based onInternational Classification of Diseases, 10th Revision (ICD-10) codes X45 (accidental poisoning by and exposure to alcohol) and Y15 (poisoning by and exposure to alcohol, undetermined intent).
^†Rates per 1 million population for persons aged ≥15 years were calculated using U.S. Census bridged-race population for 2010–2012, and were age-adjusted to the 2000 U.S. Census standard population.
^§Age-specific rate.
^¶Number of deaths was too small to meet standards of reliability and precision to calculate age-adjusted death rate.

Table 2. Average annual number of alcohol poisoning deaths,* by state — National Vital Statistics System, United States, 2010–2012
State^†	Average annual no. of deaths	Age-adjusted rate^§
Quartile 1 (5.3–6.7 death rate)
Alabama	20	5.3
Texas	109	5.4
Illinois	57	5.6
Virginia	40	5.9
Wisconsin	28	6.0
Idaho	8	6.1
Louisiana	22	6.2
Pennsylvania	68	6.5
Connecticut	19	6.6
Florida	103	6.7
Mississippi	15	6.7
New Hampshire	8	6.7
Quartile 2 (6.8–8.5 death rate)
Ohio	64	6.9
South Carolina	28	7.4
Missouri	38	7.7
Tennessee	41	7.8
Georgia	62	7.8
Arkansas	17	7.8
Maryland	37	7.8
Washington	46	8.1
Maine	9	8.1
Nebraska	11	8.1
Montana	7	8.5
Quartile 3 (8.6–11.8 death rate)
Indiana	43	8.6
North Carolina	68	8.6
New York	143	8.8
Kentucky	32	9.1
Kansas	22	9.6
Iowa	23	9.7
Michigan	77	9.7
Nevada	21	9.8
New Jersey	74	9.9
California	299	9.9
West Virginia	17	11.2
Quartile 4 (11.9–46.5 death rate)
Massachusetts	67	11.9
Oklahoma	37	12.6
Oregon	42	12.7
Colorado	60	14.4
Minnesota	73	16.4
Utah	33	16.7
South Dakota	11	17.0
Wyoming	8	17.7
Arizona	93	18.7
Rhode Island	21	22.8
New Mexico	52	32.7
Alaska	27	46.5

*Alcohol poisoning deaths included those occurring among those aged ≥15 years in which alcohol poisoning was classified as the underlying (i.e., principal) cause of death based on International Classification of Diseases, 10th Revision (ICD-10) Codes: X45 (Accidental poisoning by and exposure to alcohol), Y15 (Poisoning by and exposure to alcohol, undetermined intent).
^†The average annual number of alcohol poisoning deaths in Delaware, District of Columbia, Hawaii, North Dakota, and Vermont was less than seven and therefore, did not meet standards of reliability and precision to calculate age-adjusted death rates.
^§Rates per 1 million population for persons aged ≥15 years were calculated using U.S. Census bridged-race population for 2010–2012, and were age-adjusted to the 2000 U.S. Census standard population.