Accidental alcohol poisoning mortality in the United States, 1996-1998 - NIAAA'S Epidemiological Bulletin No.40

Alcohol Research & Health, Wntr, 2003 by Young-Hee Yoon, Frederick S. Stinson, Hsiao-Ye Yi, Mary C. Dufour

This study examines the prevalence and patterns of mortality resulting from unintentional poisoning by alcohol (ICD-9 code E860) in the United States. Relevant data for the most recently available years (1996 through 1998) were derived from the Multiple Cause of Death public-use computer data files compiled by the National Center for Health Statistics (NCHS). Data on deaths ascribed to alcohol poisoning as either the underlying cause or as 1 of up to 20 contributing causes were selected and analyzed. The annual average number of deaths for which alcohol poisoning was listed as an underlying cause was 317, with an age-adjusted death rate of 0.11 per 100,000 population. An average of 1,076 additional deaths included alcohol poisoning as a contributing cause, bringing the total number of deaths with any mention of alcohol poisoning to 1,393 per year (0.49 per 100,000 population). Males accounted for more than 80 percent of these deaths. The rate was lower among married than unmarried people (i.e., never married, divorced, or widowed) and was inversely related to education. Among males, the alcohol poisoning death rate was higher for Hispanics and non-Hispanic Blacks than non-Hispanic Whites. Among females, racial/ethnic differences were small, but Black women had higher alcohol poisoning death rates than White or Hispanic women. Alcohol poisoning deaths tended to be most prevalent among people ages 35 to 54; only 2 percent of alcohol poisoning decedents were younger than age 21. Among deaths with a contributing cause of alcohol poisoning, almost 90 percent had an underlying cause related to some type of poisoning from other drugs. KEY WORDS: AOD (alcohol and other drug) poisoning; accident mortality; AODR (alcohol and other drug related) mortality; prevalence; etiology; gender differences; age differences; racial differences; educational level achieved; risk analysis; statistical data; United States

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Beverage alcohol (i.e., ethanol) is a psychoactive drug that changes brain chemistry and can become lethal in high doses. Alcohol poisoning is an acute toxic condition resulting from exposure to excessive quantities of alcohol within a short period of time. (1) Previous studies have suggested that the prevalence of alcohol poisoning deaths is extremely low in the United States compared with some European countries (Notzon et al. 1999; Department of Health and Human Services [DHHS] 1995; Poikolainen and Vuori 1985; Caces et al. 1991). Nevertheless, the American public has become increasingly aware of the potential public health threat of alcohol poisoning. In a recent survey by the American Medical Association (2001), more than half of the respondents (53 percent of parents and 56 percent of nonparents) expressed concern about life-threatening alcohol poisoning among college students. Despite such concern, however, the current prevalence and patterns of alcohol poisoning mortality in different population groups are not well understood.

A study by Caces and colleagues (1991) concluded that alcohol poisoning fatalities appear to be rare when such deaths are attributed to a single underlying cause. (2) However, the number of deaths attributed to alcohol poisoning increases approximately fivefold under multiple-cause-of-death analysis, which considers all contributing causes (3) of death in addition to the underlying cause. Because death often results from more than one cause, the multiple-cause-of-death approach has been recommended to provide a more complete analysis of mortality statistics (Van Natta et al. 1985).

The study described in this article analyzes and compares data on deaths from alcohol poisoning as either the underlying cause or a contributing cause of death in order to advance the current understanding of death from alcohol poisoning. Age-adjusted and age-specific mortality rates of alcohol poisoning deaths coded as underlying or contributing causes are presented by sex, age, race/ethnicity, marital status, and education.

DATA AND METHODS

This study takes data on alcohol poisoning deaths from the 1996-1998 Multiple Cause of Death public-use computer data files produced by the National Center for Health Statistics (NCHS), which uses classifying codes implemented in the International Classification of Diseases, Ninth Revision (ICD-9) (World Health Organization [WHO] 1978). Data from a 3-year period were used to increase the reliability of the calculations presented here. Alcohol poisoning death rates by age, sex, and race/ethnicity were calculated using population data from the U.S. Census Bureau (1999) as denominators. Denominator data for estimating alcohol poisoning death rates by marital status and educational attainment were taken from unpublished tabulations prepared by the Housing and Household Economic Statistics Division, U.S. Census Bureau, for NCHS (see Technical Notes in Peters et al. 1998; Hoyert et al. 1999; Murphy 2000).

Deaths attributed to unintentional alcohol poisoning were identified by the ICD-9 code E860, which includes seven subclassifications (E860.0 through E860.9) (WHO 1978). (4) This study did not include deaths from intentional self-poisoning or exposure to alcohol because such deaths are not specifically coded by ICD-9. (5)