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

The underreporting of alcohol-related deaths is well documented in the alcohol epidemiology literature (e.g., Dufour 1984; Hanzlick 1988; Hudson 1978; Nashhold and Naor 1981; Pollock et al. 1987). Hudson (1978) explores the underreporting of unintentional alcohol poisoning deaths using information about alcohol testing and acute poisoning collected for 1971 from established medical examiner systems and some of the sophisticated coroners' offices in selected areas. He points out that, for various reasons, medical examiners tend to certify acute alcohol poisoning deaths as "natural," which provides an opportunity for vital statistics offices to miscode these as deaths from other alcohol-related causes, such as cirrhosis, fatty liver, or other fatal complication of alcoholism. For example, the North Carolina Office of the Chief Medical Examiner office coded 45 deaths as "accidental alcohol poisoning" in 1995. The BAC level of these cases ranged from 0.26 to 0.76 grams/deciliter (personal correspondence between Young-Hee Yoon and Patricia Barnes, Office of the Chief Medical Examiner, Chapel Hill, NC, February 14, 2003). In the national vital statistics for 1995, however, only 39 deaths in North Carolina were classified as "accidental alcohol poisoning." (10) Without more systematic studies using national-level, post mortem forensic toxicology data, it is difficult to assess to what extent and in what manner accidental poisoning deaths are underreported in national vital statistics.

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Results from this study show that middle-aged adults are at greater risk of alcohol poisoning death than younger age groups. This pattern is consistent with previous studies based on autopsy results in the United States and Finland (Taylor and Hudson 1977; Poikolainen and Vuori 1985; Lahti and Vuori 2002) showing that alcohol poisoning death is more common among experienced drinkers (i.e., alcoholics) than among inexperienced users of alcohol (e.g., youth and occasional or moderate social drinkers). Alcohol poisoning is often a complication of chronic alcoholism, and inexperienced drinkers rarely reach a lethal level of BAC (Lahti and Vuori 2002).

The results also show that among males, Hispanics and non-Hispanic Blacks have higher risk for accidental alcohol poisoning mortality than non-Hispanic Whites. This pattern is similar to the observed racial/ethnic differences in liver cirrhosis mortality (Stinson et al. 2001; Yoon et al. 2001). It is possible that drinking patterns which lead to poisoning also may contribute to liver cirrhosis mortality.

Finally, the results indicate that the risks of unintentional alcohol poisoning mortality are greater among people who are unmarried or who have completed fewer years of education. These findings are consistent with those of an earlier study conducted in Finland (Poikolainen and Vuori 1985). However, it is not clear why people who are widowed are at higher risk than those who are divorced. Further analysis is required to elucidate the various relationships between multiple demographic characteristics and alcohol poisoning death rates.