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

Alcohol Poisoning Death Rate by Marital Status

Figure 3 shows the annual average age-adjusted death rate from alcohol poisoning among adults ages 25 or older according to their marital status and sex. Death rates were lower for married than for unmarried people regardless of whether alcohol poisoning was the underlying or a contributing cause. For unmarried men and women, death rates were lowest among those who had never been married, higher among divorced people, and highest among the widowed.

The data also show that martial status had a stronger impact on the risk for alcohol poisoning death for males than for females. When alcohol poisoning was the underlying cause, the annual average age-adjusted death rate for widowed males (1.45 deaths per 100,000 population) was about 13 times the rate for married males (0.11 per 100,000 population), whereas the rate for the widowed females (0.28 deaths per 100,000 population) was about 7 times the rate for married females (0.04 deaths per 100,000 population). When alcohol poisoning was coded as a contributing cause, the age-adjusted death rate for widowed males (3.42 deaths per 100,000 population) was about 10 times as high as for married males (0.34 deaths per 100,000), whereas the rate for widowed females (0.5 deaths per 100,000 population) was about 6 times the rate for married females (0.09 deaths per 100,000 population).

Alcohol Poisoning Death Rate by Education

Figure 4 shows the annual average age-adjusted death rate from accidental alcohol poisoning for adults ages 25 to 64 by sex and educational attainment. Education was inversely related to the risk of alcohol poisoning death for both men and women. In terms of underlying cause, men with less than a high school education (0.67 deaths per 100,000 population) were more than five times as likely to die from alcohol poisoning as men with at least some college education (0.12 deaths per 100,000 population). Women with less than a high school education (0.16 deaths per 100,000 population) were more than three times as likely to die from alcohol poisoning than those with at least some college education (0.05 deaths per 100,000 population). The patterns are similar when alcohol poisoning is coded as a contributing cause.

DISCUSSION

According to data from the Toxic Exposure Surveillance System (TESS) collected by the American Association of Poison Control Centers, 55,246 people were exposed to toxic levels of alcohol in 1998. Unintentional exposure to alcoholic beverages accounted for 5,291 (10 percent) of these cases, and intentional exposure accounted for 24,155 (44 percent) of cases (Litovitz et al. 1999).

Despite the many poisoning incidents, the number of deaths from alcohol poisoning has been low, about 317 per year from 1996 through 1998, consistent with previous research findings (Notzon et al. 1999; Poikolainen and Vuori 1985; Taylor and Hudson 1977). However, the number of deaths increases fourfold when calculated by the multiple-cause method. 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 (e.g., central appetite depressants and heroin). This may result primarily from the lethal synergism between the effects of ethanol and other drugs taken concurrently (Andrews 1997; McCance-Katz et al. 1998; Ruttenber et al. 1990). However, these cases were not classified as alcohol poisoning deaths in their underlying cause because of an ICD-9 coding rule requiring that a "combination of medicinal agents with alcohol should be coded to the medicinal agent" (Lahti and Vuori 2002, p. 207). These findings underscore the importance of understanding the strong association between alcohol poisoning and other drug-related deaths. Alcohol abuse and dependence are extremely common among cocaine and heroin abusers (Brookoff et al. 1996; Carroll et al. 1993; Grant and Harford 1990; Polettini et al. 1999; Rounsaville et al. 1991; Ruttenber and Luke 1984). Furthermore, results confirm that medications such as sedatives and tranquilizers can be fatal when used in combination with alcohol (Lieber 1992; Sands et al. 1993). Based on data from official death records, Poikolainen (1984) estimated that average peak BACs at time of death were significantly lower in people who had been poisoned by a combination of ethanol and barbiturates than in people who died from ethanol poisoning alone. This suggests that even moderate drinkers may be at risk when they take certain medications and alcohol concomitantly.