Trends in Alcohol‐Related Emergency Department Visits in the United States: Results from the Nationwide Emergency Department Sample, 2006 to 2014

146

Alcohol consumption is increasing in the United States, as is alcohol-attributable mortality. Historically, men have had higher rates of alcohol consumption than women, though evidence for birth cohort effects on gender differences in alcohol consumption and alcohol-related harm suggests that gender differences may be diminishing. We review studies using U.S. national data that examined time trends in alcohol consumption and alcohol-related harm since 2008. Utilizing a historical-developmental perspective, here we synthesize and integrate the literature on birth cohort effects from varying developmental periods (i.e., adolescence, young adulthood, middle adulthood, and late adulthood), with a focus on gender differences in alcohol consumption. Findings suggest that recent trends in gender differences in alcohol outcomes are heterogeneous by developmental stage. Among adolescents and young adults, both males and females are rapidly decreasing alcohol consumption, binge and high-intensity drinking, and alcohol-related outcomes, with gender rates converging because males are decreasing consumption faster than females. This pattern does not hold among adults, however. In middle adulthood, consumption, binge drinking, and alcohol-related harms are increasing, driven largely by increases among women in their 30s and 40s. The trend of increases in consumption that are faster for women than for men appears to continue into older adult years (60 and older) across several studies. We conclude by addressing remaining gaps in the literature and offering directions for future research.

Section: Adolescencementioning

confidence: 83%

“…Harms related to alcohol are also decreasing among adolescents, with differential patterns by gender. Although alcohol‐related ED visits declined overall through 2014 (Naeger, ; White et al., ), girls aged 12 to 14 visited the ER for alcohol‐related incidents more frequently than boys of the same age (Naeger, ).…”

Section: Adolescencementioning

confidence: 99%

Is There a Recent Epidemic of Women's Drinking? A Critical Review of National Studies

Keyes

Jager

Mal-Sarkar

et al. 2019

146

“…Relatedly, from 2006 to 2016 the death rate from alcoholic liver disease increased by over 40% from 4.1 per 100,000 to 5.9 per 100,000 (CDC, ). An increase of nearly 62% in alcohol‐related emergency department (ED) visits was also found between 2006 and 2014 from 3,080,214 to 4,976,136 visits per year, with the increase occurring predominantly among people aged 45 and older (White et al., ). Further, an analysis of data from 2 waves of the National Epidemiologic Survey of Alcohol and Related Conditions showed a nearly 50% increase in the prevalence of past year alcohol use disorder (AUD) from 2002 to 2013 among adults aged 18 and above (Grant et al., ).…”

mentioning

confidence: 99%

New Estimates of the Mean Ethanol Content of Beer, Wine, and Spirits Sold in the United States Show a Greater Increase in Per Capita Alcohol Consumption than Previous Estimates

Martínez

Kerr

Subbaraman

et al. 2019

Background: Recent increases in alcohol-related morbidity and mortality have not occurred alongside notable increases in per capita alcohol consumption (PCC). This discrepancy may be partially due to U.S. PCC estimates not including annual estimates of the percentage of alcohol by volume (%ABV) of beer, wine, and spirits, but rather relying on time-invariant %ABV values.Methods: Building on a prior study covering 1950 to 2002, estimates of the annual mean %ABV of beer, wine, and spirits sold in the United States were calculated using the %ABV of major brands and sales of each beverage type for each state and nationally for the period 2003 to 2016. We applied these estimates to the calculation of annual beverage-specific and total PCC, and made descriptive comparisons between our PCC estimates and those estimates using invariant %ABV values.Results: For all beverage types, our mean %ABV estimates increased nationally and for all but 5 states. The PCC estimates from wine and spirits utilizing variable %ABV values were lower than estimates using invariant %ABV, and consumption from beer was higher. Our total PCC estimates were also lower than %ABV-invariant estimates; however, the percent change for %ABV-invariant estimates was 5.8% compared to a 7.9% change in our %ABV-variant estimates over the 2003 to 2016 period.Conclusions: Given the application of PCC estimates to understand changes in alcohol-related morbidity and mortality, the inclusion of annual estimates of the %ABV of alcoholic beverages sold in the United States is necessary to ensure the precision of PCC measures such that the conclusions drawn from these applications are accurate and valid.

“…These findings are concerning given the marked increase in binge drinking among this population over the past 15 years (Grucza et al., ) and that the physiological changes that occur with age make individuals more susceptible to alcohol‐related adverse drug reactions (Day, ; Moore et al., ). The potential interplay between changing drinking patterns and increasingly common use of these medications in the context of an aging population could be contributing substantially to the rising alcohol‐ and drug‐related emergency room visits and deaths in the United States (Case and Deaton, ; Castle et al., ; White et al., ) and highlights the need for continued surveillance of adverse events and alcohol–drug interactions, especially among middle‐aged and older adults (Breslow et al., ).…”

Section: Discussionmentioning

confidence: 99%

“…The United States has undergone sharp increases in morbidity and mortality stemming from separate and combined use of alcohol and prescription drugs. For example, the annual incidence proportion of acute alcohol‐related emergency department visits increased by 40% from 2006 to 2014—approximately 3.5% per year—and the annual incidence proportion of emergency department visits for alcohol‐related adverse drug reactions more than doubled over roughly the same period—increasing 10.7% per year (Castle et al., ; White et al., ). Although the prevalence of current alcohol use and binge drinking has been increasing, changes in drinking patterns are modest in comparison with alcohol‐related morbidity and mortality trends.…”

mentioning

confidence: 99%

Trends in Prescribed Central Nervous System Depressant Medications Among Adults Who Regularly Consume Alcohol: United States 1999 to 2014

Borodovsky

Krauss

Chi

et al. 2019

Background: Although the risks of using central nervous system depressant (CNS-D) medications with alcohol are well documented, little is known about trends in prescribed use of these medications among individuals who regularly consume alcohol (i.e., trends in "concurrent use"). We examined changes in the prevalence of prescribed CNS-D medications among individuals who drank alcohol on 52 or more occasions in the past year ("regular drinking"). CNS-D medications included sedative-hypnotics (subclassified as anxiolytics or sleep medications) and opioids.Methods: We used 8 cross-sectional cycles of the National Health and Nutrition Examination Survey (1999-2000 to 2013-2014) from participants aged 20 and older (n = 37,709). We used log-binomial regression to examine (i) prevalence trends of prescribed CNS-D medication use, (ii) trend differences by drinking status, and (iii) correlates of CNS-D medication use.Results: Among those who drink regularly, the relative annual increase in prevalence of sedativehypnotic use was 5.3% (95% CI: 2.7 to 7.9): Anxiolytic and sleep medication use increased annually by 3.7% (95% CI: 0.8 to 6.7) and 11.2% (95% CI: 6.5 to 16.0), respectively. Opioid use trends among those who drink regularly were not statistically significant but were nonlinear. Differences in CNS-D medication trends between those who drink regularly and those who drink infrequently/abstain were not statistically significant. Those who drink regularly were less likely than those who drink infrequently/abstain to use opioids (adjusted relative risk [ARR]: 0.69, 95% CI: 0.60 to 0.78) and anxiolytics (ARR: 0.71, 95% CI: 0.61 to 0.81), but not sleep medications (ARR: 1.04, 95% CI: 0.80 to 1.35). Those aged 40 and older were 2 to 5 times as likely as those aged 20 to 29 to use sedative-hypnotics.Conclusions: Among those who drink regularly, the prevalence of prescribed sedative-hypnotic use increased and prescribed opioid use remained common. These trends indicate that a substantial portion of the population is at risk of alcohol-related adverse drug reactions-particularly those aged 40 and older.