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.

Conclusions and Comment

The results in this report indicate that during 2010–2012 there was an average of six deaths from alcohol poisoning each day among persons aged ≥15 years in the United States. Three in four of these deaths involved adults aged 35–64 years, and three in four of these deaths involved males. Nearly 70% of the deaths were among non-Hispanic whites; however, the highest alcohol poisoning death rate was among American Indians/Alaska Natives (49.1 deaths per 1 million).

The large proportion of alcohol poisoning deaths (75.7%) among adults aged 35–64 years is consistent with recent findings that two thirds (69%) of all average annual alcohol-attributable deaths in the United States involve adults aged 20–64 years.^[1] Alcohol-attributable deaths also result in substantial losses in workplace productivity and were responsible for >70% of the $223.5 billion in economic costs attributed to excessive drinking in the United States in 2006.^[2] This finding also is consistent with the distribution of binge drinking episodes in the United States, most of which are reported by adults aged ≥26 years.^[11]

The large proportion of alcohol poisoning deaths among non-Hispanic whites is consistent with the high prevalence of binge drinking in this population.^[4] The high alcohol poisoning death rate among American Indians/Alaska Natives also is consistent with the high binge drinking intensity that has been reported by binge drinkers in this population.^[4] A recent study found that American Indians/Alaska Natives were seven times more likely to die from alcohol poisoning than whites, reflecting both the higher intensity of binge drinking among binge drinkers in this population and other factors, such as geographic isolation and reduced access to medical care.^[12]

Differences in alcohol poisoning death rates in states reflect known differences in state binge drinking patterns, which are strongly influenced by state and local laws governing the price and availability of alcohol,^[13] as well as other cultural and religious factors.^[14] A recent study that examined the relationship between various subgroups of state alcohol policies and binge drinking among adults found that a small number of policies that raised alcohol prices and reduced its availability had the greatest impact on binge drinking in states.^[15] However, other factors, in addition to differences in binge drinking rates, also might be important contributors to differences in alcohol poisoning death rates. For example, living in geographically isolated rural areas might increase the likelihood that a person with alcohol poisoning will not be found before death or that timely emergency medical services will not be available.

Although alcohol dependence was a contributing cause of death in 30% of alcohol poisoning deaths, the majority of these deaths involved persons for whom alcohol dependence was not listed as a contributing cause of death. This result is consistent with the results of a recent study that found that nine in 10 adults who drink excessively were not alcohol dependent, including more than two thirds of those who reported binge drinking ≥10 times per month.^[5]

The findings in this analysis are subject to at least three limitations. First, alcohol-attributable deaths, including alcohol poisoning, are underreported.^[16–18] Second, this study was restricted to deaths in which alcohol poisoning was the underlying cause of death, and did not include deaths in which alcohol poisoning was a contributing cause of death. A previous study found that there were three times as many deaths in which alcohol poisoning was a contributing, rather than underlying cause of death..^[19] Finally, mortality data might underestimate the actual number of deaths for American Indians/Alaska Natives^[12] and certain other racial/ethnic populations (e.g., Hispanics) because of misclassification of race/ethnicity of the decedents on death certificates.^[20]

There are several recommended evidence-based, population-level strategies to reduce excessive drinking and related harms, such as regulating alcohol outlet density (i.e., the concentration of retail alcohol establishments, including bars and restaurants and liquor or package stores, in a given geographic area) and preventing illegal alcohol sales in retail settings (e.g., commercial host [dram shop] liability).^[21,22] The status of each state's policies related to some of these recommendations are available from CDC online (at https://www.cdc.gov/psr/alcohol). Screening and brief intervention for excessive alcohol use, including binge drinking, among adults has also been recommended.^[23] However, a recent study found that only one in six U.S. adults overall, one in five current drinkers, and one in four binge drinkers in 44 states and the District of Columbia reported ever discussing alcohol use with a doctor or other health professional. Furthermore, 65.1% of those who reported binge drinking ≥10 times in the past month had never had this dialogue.^[24]

Death from alcohol poisoning is a serious and preventable public health problem in the United States. A comprehensive approach to the prevention of excessive drinking that includes evidence-based community and clinical prevention strategies is needed to decrease alcohol poisoning deaths and other harms attributable to excessive alcohol use.

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Acknowledgments
Arialdi M. Miniño, MPH, Melonie Heron, PhD, Elizabeth Arias, PhD, Robert N. Anderson, PhD, Jennifer Madans, PhD, National Center for Health Statistics, CDC.

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.